U.S. patent number 10,660,692 [Application Number 15/355,875] was granted by the patent office on 2020-05-26 for end effector for instrument with ultrasonic blade and bipolar clamp arm.
This patent grant is currently assigned to Ethicon LLC. The grantee listed for this patent is Ethicon Endo-Surgery, LLC. Invention is credited to Adam Brown, Ellen Burkart, Kai Chen, William E. Clem, Catherine A. Corbett, Nathan Cummings, William D. Dannaher, Mark A. Davison, Craig N. Faller, Christina M. Hough, Jason R. Lesko, Jeffrey D. Messerly, William B. Weisenburgh, II, Barry C. Worrell.
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United States Patent |
10,660,692 |
Lesko , et al. |
May 26, 2020 |
End effector for instrument with ultrasonic blade and bipolar clamp
arm
Abstract
An apparatus includes a body, a shaft assembly, and an end
effector. The end effector includes an ultrasonic blade and a clamp
arm assembly. The ultrasonic blade is in acoustic communication
with an acoustic waveguide of the shaft assembly. The clamp arm
assembly is pivotable toward and away from the ultrasonic blade.
The clamp arm assembly includes a first electrode and a second
electrode. The first and second electrodes are operable to
cooperate to apply bipolar RF energy to tissue.
Inventors: |
Lesko; Jason R. (Cincinnati,
OH), Corbett; Catherine A. (Cincinnati, OH), Weisenburgh,
II; William B. (Maineville, OH), Worrell; Barry C.
(Centerville, OH), Davison; Mark A. (Maineville, OH),
Cummings; Nathan (Cincinnati, OH), Burkart; Ellen
(Cincinnati, OH), Dannaher; William D. (Cincinnati, OH),
Hough; Christina M. (Cincinnati, OH), Faller; Craig N.
(Batavia, OH), Brown; Adam (Cincinnati, OH), Messerly;
Jeffrey D. (Cincinnati, OH), Chen; Kai (Millburn,
NJ), Clem; William E. (Bozeman, MT) |
Applicant: |
Name |
City |
State |
Country |
Type |
Ethicon Endo-Surgery, LLC |
Guaynabo |
PR |
US |
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Assignee: |
Ethicon LLC (Guaynabo,
PR)
|
Family
ID: |
57681757 |
Appl.
No.: |
15/355,875 |
Filed: |
November 18, 2016 |
Prior Publication Data
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Document
Identifier |
Publication Date |
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US 20170164973 A1 |
Jun 15, 2017 |
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Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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62265611 |
Dec 10, 2015 |
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62324428 |
Apr 19, 2016 |
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62365543 |
Jul 22, 2016 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B
18/1445 (20130101); A61B 18/1206 (20130101); A61B
17/320092 (20130101); A61B 2017/320095 (20170801); A61B
2018/00922 (20130101); A61B 2018/1455 (20130101); A61B
2018/00083 (20130101); A61B 2018/00619 (20130101); A61B
2018/0063 (20130101); A61B 2018/00202 (20130101); A61B
2018/00791 (20130101); A61B 2018/00077 (20130101); A61B
2018/126 (20130101); A61B 2017/320094 (20170801); A61B
2018/00404 (20130101); A61B 2018/00595 (20130101); A61B
2018/00994 (20130101); A61B 2018/00607 (20130101); A61B
2018/142 (20130101) |
Current International
Class: |
A61B
18/12 (20060101); A61B 18/14 (20060101); A61B
17/32 (20060101); A61B 18/00 (20060101) |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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WO 2008/118709 |
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Oct 2008 |
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WO |
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WO 2017/100423 |
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Jun 2017 |
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WO |
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WO 2017/100427 |
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Jun 2017 |
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WO |
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Other References
International Search Report and Written Opinion dated Feb. 2, 2018
for Application No. PCT/US2017/057871, 11 pgs. cited by applicant
.
U.S. Appl. No. 14/928,375, filed Oct. 30, 2015. cited by applicant
.
U.S. Appl. No. 15/355,875, filed Nov. 18, 2016. cited by applicant
.
U.S. Appl. No. 15/355,892, filed Nov. 18, 2016. cited by applicant
.
U.S. Appl. No. 61/410,603, filed Nov. 5, 2010. cited by applicant
.
U.S. Appl. No. 62/265,611, filed Dec. 10, 2015. cited by applicant
.
U.S. Appl. No. 62/324,428, filed Apr. 19, 2016. cited by applicant
.
U.S. Appl. No. 62/365,543, filed Jul. 22, 2016. cited by applicant
.
International Search Report and Written Opinion dated Sep. 25, 2017
for Application No. PCT/US2016/065570, 15 pgs. cited by applicant
.
International Search Report and Written Opinion dated Sep. 25, 2017
for Application No. PCT/US2016/065575, 13 pgs. cited by applicant
.
U.S. Appl. No. 15/355,836. cited by applicant .
U.S. Appl. No. 15/355,892. cited by applicant.
|
Primary Examiner: Fowler; Daniel W
Attorney, Agent or Firm: Frost Brown Todd LLC
Parent Case Text
PRIORITY
This application claims priority to U.S. Provisional Pat. App. No.
62/265,611, entitled "End Effector for Instrument with Ultrasonic
and Electrosurgical Features," filed Dec. 10, 2015, the disclosure
of which is incorporated by reference herein.
This application also claims priority to U.S. Provisional Pat. App.
No. 62/324,428, entitled "End Effector for Instrument with
Ultrasonic and Electrosurgical Features," filed Apr. 19, 2016, the
disclosure of which is incorporated by reference herein.
This application also claims priority to U.S. Provisional Pat. App.
No. 62/365,543, entitled "End Effector for Instrument with
Ultrasonic and Electrosurgical Features," filed Jul. 22, 2016, the
disclosure of which is incorporated by reference herein.
Claims
We claim:
1. An apparatus comprising: (a) a body; (b) a shaft assembly
extending longitudinally and distally from the body, wherein the
shaft assembly comprises an acoustic waveguide, wherein the
acoustic waveguide is configured to communicate ultrasonic
vibrations; and (c) an end effector, wherein the end effector
comprises: (i) an ultrasonic blade in acoustic communication with
the acoustic waveguide, and (ii) a clamp arm assembly, wherein the
clamp arm assembly is pivotable toward and away from the ultrasonic
blade, wherein the clamp arm assembly comprises: (A) a clamp arm
body, (B) a first electrode having a first body portion and a first
terminal, wherein the first body portion has a first exposed
surface longitudinally extending along a first surface centerline,
facing toward the ultrasonic blade, and configured to engage
tissue, wherein the first terminal is laterally offset from the
first surface centerline and transversely extends from the first
body portion toward the clamp arm body such that the first terminal
is electrically connected to the first exposed surface, and (C) a
second electrode having a second body portion and a second
terminal, wherein the second body portion has a second exposed
surface longitudinally extending along a second surface centerline,
facing toward the ultrasonic blade, and configured to engage
tissue, wherein the second terminal is laterally offset from the
second surface centerline and transversely extends from the second
body portion toward the clamp arm body such that the second
terminal is electrically connected to the second exposed surface,
wherein the first and second electrodes are operable to cooperate
to apply bipolar RF energy to tissue.
2. The apparatus of claim 1, wherein the clamp arm assembly defines
a length, wherein the first and second electrodes extend
longitudinally along the length of the clamp arm assembly.
3. The apparatus of claim 1, wherein the first electrode is
laterally offset from the second electrode.
4. The apparatus of claim 1, wherein the clamp arm assembly further
comprises a clamp pad, wherein the clamp pad is operable to
compress tissue against the ultrasonic blade, and wherein the first
and second terminals transversely extend through the clamp pad.
5. The apparatus of claim 4, wherein the clamp arm body defines a
first opening that receives a first portion of the clamp pad,
wherein the first terminal transversely extends through the first
portion of the clamp pad and the first opening such that the first
terminal is laterally interposed between the clamp pad and the
clamp arm body.
6. The apparatus of claim 5, wherein the clamp pad has a tissue
engaging surface and defines a plurality of openings through the
tissue engaging surface associated with the first and second
electrodes, wherein the openings are configured to provide tissue
access to the first and second electrodes through the clamp pad,
and wherein the first and second electrodes are recessed within the
plurality of openings, respectively, relative to the tissue
engaging surface.
7. The apparatus of claim 4, wherein the first electrode defines a
first half of the clamp arm body, wherein the second electrode
defines a second half of the clamp arm body, wherein the clamp pad
is laterally interposed between the first and second electrodes,
wherein the clamp pad includes an electrically insulative
material.
8. The apparatus of claim 4, wherein the clamp arm body defines a
plurality of lateral notches, wherein the lateral notches are
configured to receive an outward flow of material forming the clamp
pad.
9. The apparatus of claim 4, wherein the first electrode comprises
a first wire extending along at least a portion of a length of the
clamp pad, wherein the second electrode comprises a second wire
extending along at least a portion of a length of the clamp pad,
wherein portions of the first and second wires are exposed relative
to the clamp pad to enable contact with tissue being compressed
against the ultrasonic blade by the clamp pad.
10. The apparatus of claim 1, wherein the first electrode comprises
a first plurality of laterally extending portions, wherein the
first plurality of laterally extending portions of the first
electrode are longitudinally spaced apart from each other, wherein
the second electrode comprises a second plurality of laterally
extending portions, wherein the second plurality of laterally
extending portions of the second electrode are longitudinally
spaced apart from each other.
11. The apparatus of claim 4, wherein the clamp arm body has an
outer surface facing away from the ultrasonic blade and defines a
first opening transversely extending through the outer surface,
wherein the first opening receives a first portion of the clamp pad
such that the first portion of the clamp pad is exposed through the
first opening.
12. The apparatus of claim 11, wherein the first terminal
transversely extends through the first portion of the clamp pad and
the first opening such that the first terminal is exposed and
accessible via the first opening.
13. The apparatus of claim 12, wherein the first terminal
transversely extends from the first body portion transversely
beyond the outer surface of the clamp arm body.
14. The apparatus of claim 12, wherein the second terminal
transversely extends through the first portion of the clamp pad and
the first opening such that the second terminal is exposed and
accessible via the first opening.
15. An apparatus comprising: (a) a body; (b) a shaft assembly
extending longitudinally and distally from the body, wherein the
shaft assembly comprises an acoustic waveguide, wherein the
acoustic waveguide is configured to communicate ultrasonic
vibrations; and (c) an end effector, wherein the end effector
comprises: (i) an ultrasonic blade in acoustic communication with
the acoustic waveguide, and (ii) a clamp arm assembly, wherein the
clamp arm assembly is pivotable toward and away from the ultrasonic
blade between an open position and a closed position relative to
the ultrasonic blade, wherein the clamp arm assembly comprises: (A)
a clamp arm body having an outer surface facing away from the
ultrasonic blade and defining a first opening transversely
extending through the outer surface, (B) a clamp pad defining a
first bore and a second bore and having a first pad portion
received within the first opening of the clamp arm body such that
the first pad portion is exposed through the first opening, (C) a
first electrode received at least partially within the first bore
and captured therein in each of the open and closed positions, and
(D) a second electrode received at least partially within the
second bore and captured therein in each of the open and closed
positions, wherein the first and second electrodes are operable to
cooperate to apply bipolar RF energy to tissue.
16. The apparatus of claim 15, wherein the clamp arm body further
defines a second opening transversely extending through the outer
surface, and wherein the clamp pad has a second pad portion
received within the second opening of the clamp arm body such that
the second pad portion is exposed through the second opening.
17. The apparatus of claim 16, wherein the first electrode is
laterally spaced apart from the second electrode, wherein at least
a portion of the first electrode is longitudinally and laterally
surrounded by the first pad portion received within the first
opening of the clamp arm body, and wherein at least a portion of
the second electrode is longitudinally and laterally surrounded by
the second pad portion received within the second opening of the
clamp arm body.
18. The apparatus of claim 15, wherein each of the first and second
bores transversely extend through an entirety of the clamp pad.
19. A method of treating a tissue with a surgical instrument,
wherein the surgical instrument includes (a) a body; (b) a shaft
assembly extending longitudinally and distally from the body,
wherein the shaft assembly comprises an acoustic waveguide, wherein
the acoustic waveguide is configured to communicate ultrasonic
vibrations; and (c) an end effector, wherein the end effector
comprises: (i) an ultrasonic blade in acoustic communication with
the acoustic waveguide, and (ii) a clamp arm assembly, wherein the
clamp arm assembly is pivotable toward and away from the ultrasonic
blade, wherein the clamp arm assembly comprises: (A) a clamp arm
body, (B) a first electrode having a first body portion and a first
terminal, wherein the first terminal transversely extends from the
first body portion toward the clamp arm body such that the first
terminal transversely extends entirely through and transversely
beyond the clamp arm body, and (C) a second electrode having a
second body portion and a second terminal, wherein the second
terminal transversely extends from the second body portion toward
the clamp arm body such that the second terminal transversely
extends entirely through and transversely beyond the clamp arm
body, wherein the first and second electrodes are operable to
cooperate to apply bipolar RF energy to tissue, the method
comprising: (a) applying bipolar RF energy at the first and second
terminals projecting transversely beyond the clamp arm body to
communicate the bipolar RF energy along the first and second body
portions and to the tissue to thereby treat the tissue.
Description
BACKGROUND
A variety of surgical instruments include an end effector having a
blade element that vibrates at ultrasonic frequencies to cut and/or
seal tissue (e.g., by denaturing proteins in tissue cells). These
instruments include one or more piezoelectric elements that convert
electrical power into ultrasonic vibrations, which are communicated
along an acoustic waveguide to the blade element. The precision of
cutting and coagulation may be controlled by the operator's
technique and adjusting the power level, blade edge angle, tissue
traction, and blade pressure. The power level used to drive the
blade element may be varied (e.g., in real time) based on sensed
parameters such as tissue impedance, tissue temperature, tissue
thickness, and/or other factors. Some instruments have a clamp arm
and clamp pad for grasping tissue with the blade element.
Examples of ultrasonic surgical instruments include the HARMONIC
ACE.RTM. Ultrasonic Shears, the HARMONIC WAVE.RTM. Ultrasonic
Shears, the HARMONIC FOCUS.RTM. Ultrasonic Shears, and the HARMONIC
SYNERGY.RTM. Ultrasonic Blades, all by Ethicon Endo-Surgery, Inc.
of Cincinnati, Ohio. Further examples of such devices and related
concepts are disclosed in U.S. Pat. No. 5,322,055, entitled "Clamp
Coagulator/Cutting System for Ultrasonic Surgical Instruments,"
issued Jun. 21, 1994, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 5,873,873, entitled "Ultrasonic
Clamp Coagulator Apparatus Having Improved Clamp Mechanism," issued
Feb. 23, 1999, the disclosure of which is incorporated by reference
herein; U.S. Pat. No. 5,980,510, entitled "Ultrasonic Clamp
Coagulator Apparatus Having Improved Clamp Arm Pivot Mount," issued
Nov. 9, 1999, the disclosure of which is incorporated by reference
herein; U.S. Pat. No. 6,283,981, entitled "Method of Balancing
Asymmetric Ultrasonic Surgical Blades," issued Sep. 4, 2001, the
disclosure of which is incorporated by reference herein; U.S. Pat.
No. 6,309,400, entitled "Curved Ultrasonic Blade having a
Trapezoidal Cross Section," issued Oct. 30, 2001, the disclosure of
which is incorporated by reference herein; U.S. Pat. No. 6,325,811,
entitled "Blades with Functional Balance Asymmetries for use with
Ultrasonic Surgical Instruments," issued Dec. 4, 2001, the
disclosure of which is incorporated by reference herein; U.S. Pat.
No. 6,423,082, entitled "Ultrasonic Surgical Blade with Improved
Cutting and Coagulation Features," issued Jul. 23, 2002, the
disclosure of which is incorporated by reference herein; U.S. Pat.
No. 6,773,444, entitled "Blades with Functional Balance Asymmetries
for Use with Ultrasonic Surgical Instruments," issued Aug. 10,
2004, the disclosure of which is incorporated by reference herein;
U.S. Pat. No. 6,783,524, entitled "Robotic Surgical Tool with
Ultrasound Cauterizing and Cutting Instrument," issued Aug. 31,
2004, the disclosure of which is incorporated by reference herein;
U.S. Pat. No. 8,057,498, entitled "Ultrasonic Surgical Instrument
Blades," issued Nov. 15, 2011, the disclosure of which is
incorporated by reference herein; U.S. Pat. No. 8,461,744, entitled
"Rotating Transducer Mount for Ultrasonic Surgical Instruments,"
issued Jun. 11, 2013, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 8,591,536, entitled "Ultrasonic
Surgical Instrument Blades," issued Nov. 26, 2013, the disclosure
of which is incorporated by reference herein; and U.S. Pat. No.
8,623,027, entitled "Ergonomic Surgical Instruments," issued Jan.
7, 2014, the disclosure of which is incorporated by reference
herein.
Still further examples of ultrasonic surgical instruments are
disclosed in U.S. Pub. No. 2006/0079874, entitled "Tissue pad for
Use with an Ultrasonic Surgical Instrument," published Apr. 13,
2006, now abandoned, the disclosure of which is incorporated by
reference herein; U.S. Pub. No. 2007/0191713, entitled "Ultrasonic
Device for Cutting and Coagulating," published Aug. 16, 2007, now
abandoned, the disclosure of which is incorporated by reference
herein; U.S. Pub. No. 2007/0282333, entitled "Ultrasonic Waveguide
and Blade," published Dec. 6, 2007, now abandoned, the disclosure
of which is incorporated by reference herein; U.S. Pub. No.
2008/0200940, entitled "Ultrasonic Device for Cutting and
Coagulating," published Aug. 21, 2008, now abandoned, the
disclosure of which is incorporated by reference herein; U.S. Pub.
No. 2008/0234710, entitled "Ultrasonic Surgical Instruments,"
published Sep. 25, 2008, issued as U.S. Pat. No. 8,911,460 on Dec.
16, 2014, the disclosure of which is incorporated by reference
herein; and U.S. Pub. No. 2010/0069940, entitled "Ultrasonic Device
for Fingertip Control," published Mar. 18, 2010, issued as U.S.
Pat. No. 9,023,071 on May 5, 2015, the disclosure of which is
incorporated by reference herein.
Some ultrasonic surgical instruments may include a cordless
transducer such as that disclosed in U.S. Pub. No. 2012/0112687,
entitled "Recharge System for Medical Devices," published May 10,
2012, issued as U.S. Pat. No.9,381,058 on Jul. 5, 2016, the
disclosure of which is incorporated by reference herein; U.S. Pub.
No. 2012/0116265, entitled "Surgical Instrument with Charging
Devices," published May 10, 2012, now abandoned, the disclosure of
which is incorporated by reference herein; and/or U.S. Pat. App.
No. 61/410,603, filed Nov. 5, 2010, entitled "Energy-Based Surgical
Instruments," the disclosure of which is incorporated by reference
herein.
Additionally, some ultrasonic surgical instruments may include an
articulating shaft section. Examples of such ultrasonic surgical
instruments are disclosed in U.S. Pub. No. 2014/0005701, published
Jan. 2, 2014, issued as U.S. Pat. No. 9,393,037 on Jul. 19, 2016,
entitled "Surgical Instruments with Articulating Shafts," the
disclosure of which is incorporated by reference herein; and U.S.
Pub. No. 2014/0114334, published Apr. 24, 2014, issued as U.S. Pat.
No. 9,095,367 on Aug. 4, 2015, entitled "Flexible Harmonic
Waveguides/Blades for Surgical Instruments," the disclosure of
which is incorporated by reference herein.
Some instruments are operable to seal tissue by applying
radiofrequency (RF) electrosurgical energy to the tissue. An
example of a surgical instrument that is operable to seal tissue by
applying RF energy to the tissue is the ENSEAL.RTM. Tissue Sealing
Device by Ethicon Endo-Surgery, Inc., of Cincinnati, Ohio. Further
examples of such devices and related concepts are disclosed in U.S.
Pat. No. 6,500,176 entitled "Electrosurgical Systems and Techniques
for Sealing Tissue," issued Dec. 31, 2002, the disclosure of which
is incorporated by reference herein; U.S. Pat. No. 7,112,201
entitled "Electrosurgical Instrument and Method of Use," issued
Sep. 26, 2006, the disclosure of which is incorporated by reference
herein; U.S. Pat. No. 7,125,409, entitled "Electrosurgical Working
End for Controlled Energy Delivery," issued Oct. 24, 2006, the
disclosure of which is incorporated by reference herein; U.S. Pat.
No. 7,169,146 entitled "Electrosurgical Probe and Method of Use,"
issued Jan. 30, 2007, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 7,186,253, entitled
"Electrosurgical Jaw Structure for Controlled Energy Delivery,"
issued Mar. 6, 2007, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 7,189,233, entitled
"Electrosurgical Instrument," issued Mar. 13, 2007, the disclosure
of which is incorporated by reference herein; U.S. Pat. No.
7,220,951, entitled "Surgical Sealing Surfaces and Methods of Use,"
issued May 22, 2007, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 7,309,849, entitled "Polymer
Compositions Exhibiting a PTC Property and Methods of Fabrication,"
issued Dec. 18, 2007, the disclosure of which is incorporated by
reference herein; U.S. Pat. No. 7,311,709, entitled
"Electrosurgical Instrument and Method of Use," issued Dec. 25,
2007, the disclosure of which is incorporated by reference herein;
U.S. Pat. No. 7,354,440, entitled "Electrosurgical Instrument and
Method of Use," issued Apr. 8, 2008, the disclosure of which is
incorporated by reference herein; U.S. Pat. No. 7,381,209, entitled
"Electrosurgical Instrument," issued Jun. 3, 2008, the disclosure
of which is incorporated by reference herein.
Some instruments are capable of applying both ultrasonic energy and
RF electrosurgical energy to tissue. Examples of such instruments
are described in U.S. Pub. No. 2015/0141981, entitled "Ultrasonic
Surgical Instrument with Electrosurgical Feature," published May
21, 2015, issued as U.S. Pat. No. 9,949,785 on Apr. 24, 2018, the
disclosure of which is incorporated by reference herein; and U.S.
Pat. No. 8,663,220, entitled "Ultrasonic Electrosurgical
Instruments," issued Mar. 4, 2014, the disclosure of which is
incorporated by reference herein.
While several surgical instruments and systems have been made and
used, it is believed that no one prior to the inventors has made or
used the invention described in the appended claims.
BRIEF DESCRIPTION OF THE DRAWINGS
While the specification concludes with claims which particularly
point out and distinctly claim this technology, it is believed this
technology will be better understood from the following description
of certain examples taken in conjunction with the accompanying
drawings, in which like reference numerals identify the same
elements and in which:
FIG. 1 depicts a side elevational view of an exemplary surgical
instrument;
FIG. 2 depicts a perspective view of another exemplary clamp arm
assembly of an end effector that may be incorporated into the
instrument of FIG. 1;
FIG. 3 depicts an exploded view of the clamp arm assembly of FIG. 2
and an ultrasonic blade that forms an end effector with the clamp
arm assembly of FIG. 2;
FIG. 4 depicts a bottom view of the clamp arm assembly of FIG.
2;
FIG. 5 depicts a perspective cross-sectional view of the clamp arm
assembly of FIG. 4 taken along line 5-5 of FIG. 4;
FIG. 6 depicts a bottom view of another exemplary clamp arm
assembly of an end effector that may be incorporated into the
instrument of FIG. 1;
FIG. 7 depicts a perspective cross-sectional view of the clamp arm
assembly of FIG. 6 taken along line 7-7 of FIG. 6;
FIG. 8A depicts a cross-sectional view of another exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the cross-sectional view taken prior to machining;
FIG. 8B depicts a cross-sectional view of the end effector of FIG.
8A taken after machining;
FIG. 9A depicts a cross-sectional view of another exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the cross-sectional view taken prior to machining;
FIG. 9B depicts a cross-sectional view of the end effector of FIG.
8A taken after machining;
FIG. 10 depicts a perspective view of another exemplary clamp arm
assembly of an end effector that may be incorporated into the
instrument of FIG. 1;
FIG. 11 depicts a perspective view of another exemplary clamp arm
assembly of an end effector that may be incorporated into the
instrument of FIG. 1;
FIG. 12 depicts an exploded view of the clamp arm assembly of FIG.
10;
FIG. 13A depicts a bottom view of the clamp arm assembly of FIG.
10;
FIG. 13B depicts a perspective cross-sectional view of the clamp
arm assembly of FIG. 13A, taken along line 13B-13B of FIG. 13A;
FIG. 14A depicts a bottom view of another exemplary clamp arm
assembly of an end effector that may be incorporated into the
instrument of FIG. 1;
FIG. 14B depicts a perspective cross-sectional view of the clamp
arm assembly of FIG. 14A, taken along line 14B-14B of FIG. 14A;
FIG. 15A depicts a bottom view of another exemplary clamp arm
assembly of an end effector that may be incorporated into the
instrument of FIG. 1;
FIG. 15B depicts a perspective cross-sectional view of the clamp
arm assembly of FIG. 15A, taken along line 15B-15B of FIG. 15A;
FIG. 16 depicts a perspective view of another exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the end effector in a closed configuration;
FIG. 17 depicts another perspective view of the end effector of
FIG. 16;
FIG. 18 depicts a perspective view of the clamp arm assembly of
FIG. 16;
FIG. 19 depicts a perspective cross-sectional view of the end
effector of FIG. 16;
FIG. 20A depicts another perspective cross-sectional view of the
end effector of FIG. 16;
FIG. 20B depicts another perspective cross-sectional view of the
end effector of FIG. 16;
FIG. 21 depicts a side view of another exemplary end effector,
shown without the blade, that may be incorporated into the
instrument of FIG. 1;
FIG. 22A depicts a cross-section view of the end effector of FIG.
21 taken along line 22A-22A of FIG. 21;
FIG. 22B depicts a cross-section view of the end effector of FIG.
21 taken along line 22B-22B of FIG. 21;
FIG. 22C depicts a bottom view of the end effector of FIG. 21 taken
along line 22C-22C of FIG. 21;
FIG. 23 depicts a bottom view of another exemplary end effector,
shown without the blade, that may be incorporated into the
instrument of FIG. 1;
FIG. 24 depicts a cross-section view of another exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the end effector in a closed configuration;
FIG. 25 depicts an end view of the end effector of FIG. 24, with
the end effector compressing tissue between the clamp arm and the
ultrasonic blade;
FIG. 26 depicts a cross-section view of another exemplary end
effector that may be incorporated into the instrument of FIG. 1,
with the end effector in a closed configuration;
FIG. 27 depicts a perspective view of another exemplary end
effector that may be incorporated into the instrument of FIG.
1;
FIG. 28 depicts an end view of a portion of the end effector of
FIG. 27;
FIG. 29 depicts a perspective view of another exemplary end
effector that may be incorporated into the instrument of FIG.
1;
FIG. 30 depicts a cross-section view of the end effector of FIG.
29, taken along line 30-30 of FIG. 29;
FIG. 31 depicts a cross-section view of another exemplary end
effector that may be incorporated into the instrument of FIG.
1;
FIG. 32 depicts a perspective view of the clamp arm of the end
effector of FIG. 31;
FIG. 33 depicts another perspective view of the clamp arm of the
end effector of FIG. 31;
FIG. 34 depicts another cross-section view of the clamp arm of the
end effector of FIG. 31;
FIG. 35 depicts a partial exploded view of the end effector of FIG.
31, with a tube assembly that may be incorporated into the shaft
assembly of FIG. 1 and used with the end effector of FIG. 31;
FIG. 36 depicts a cross-section view of the tube assembly of FIG.
35;
FIG. 37 depicts an exploded view of another exemplary tube assembly
that may be incorporated into the shaft assembly of FIG. 1 and used
with the end effector of FIG. 31;
FIG. 38 depicts a perspective view of the tube assembly of FIG.
37;
FIG. 39 depicts a side view of a proximal portion of the tube
assembly of FIG. 35, showing electrical connections of the tube
assembly with electrical components;
FIG. 40 depicts a perspective view of the proximal portion of the
tube assembly of FIG. 39;
FIG. 41 depicts a perspective view of an exemplary actuation ring
usable with the end effector of FIG. 31 to open and close the end
effector;
FIG. 42 depicts a cross-section view of another exemplary end
effector that may be incorporated into the instrument of FIG.
1;
FIG. 43 depicts a bottom view of an exemplary clamp pad of the end
effector of FIG. 42;
FIG. 44 depicts a bottom view of another exemplary clamp pad of the
end effector of FIG. 42;
FIG. 45 depicts a side view of another exemplary end effector,
shown in a shear device;
FIG. 46 depicts a cross-section view of the end effector of FIG. 45
taken along the distal section at line A-A of FIG. 45;
FIG. 47 depicts a cross-section view of the end effector of FIG. 45
taken along the proximal section at line B-B of FIG. 45;
FIG. 48 depicts a cross-section view of another version of the end
effector of FIG. 45 taken along the distal section at line A-A of
FIG. 45;
FIG. 49 depicts a cross-section view of the end effector of FIG. 48
taken along the proximal section at line B-B of FIG. 45;
FIG. 50 depicts a perspective view in side cross-section of another
version of the end effector of FIG. 45;
FIG. 51 depicts a perspective view in end cross-section of the end
effector of FIG. 50;
FIG. 52 depicts a cross-section view of another exemplary end
effector that may be incorporated into the instrument of FIG.
1;
FIG. 53 depicts a cross-section view of another exemplary end
effector that may be incorporated into the instrument of FIG.
1;
FIG. 54 depicts a cross-section view of another exemplary end
effector that may be incorporated into the instrument of FIG.
1;
FIG. 55 depicts a cross-section view of an exemplary alternative
clamp pad to clamp arm arrangement that may be incorporated into
the instrument of FIG. 1;
FIG. 56 depicts a cross-section view of another exemplary
alternative clamp pad to clamp arm arrangement that may be
incorporated into the instrument of FIG. 1; and
FIG. 57 depicts a cross-section view of another exemplary
alternative clamp pad to clamp arm arrangement that may be
incorporated into the instrument of FIG. 1.
The drawings are not intended to be limiting in any way, and it is
contemplated that various embodiments of the technology may be
carried out in a variety of other ways, including those not
necessarily depicted in the drawings. The accompanying drawings
incorporated in and forming a part of the specification illustrate
several aspects of the present technology, and together with the
description serve to explain the principles of the technology; it
being understood, however, that this technology is not limited to
the precise arrangements shown.
DETAILED DESCRIPTION
The following description of certain examples of the technology
should not be used to limit its scope. Other examples, features,
aspects, embodiments, and advantages of the technology will become
apparent to those skilled in the art from the following
description, which is by way of illustration, one of the best modes
contemplated for carrying out the technology. As will be realized,
the technology described herein is capable of other different and
obvious aspects, all without departing from the technology.
Accordingly, the drawings and descriptions should be regarded as
illustrative in nature and not restrictive.
It is further understood that any one or more of the teachings,
expressions, embodiments, examples, etc. described herein may be
combined with any one or more of the other teachings, expressions,
embodiments, examples, etc. that are described herein. The
following-described teachings, expressions, embodiments, examples,
etc. should therefore not be viewed in isolation relative to each
other. Various suitable ways in which the teachings herein may be
combined will be readily apparent to those of ordinary skill in the
art in view of the teachings herein. Such modifications and
variations are intended to be included within the scope of the
claims.
For clarity of disclosure, the terms "proximal" and "distal" are
defined herein relative to a human or robotic operator of the
surgical instrument. The term "proximal" refers the position of an
element closer to the human or robotic operator of the surgical
instrument and further away from the surgical end effector of the
surgical instrument. The term "distal" refers to the position of an
element closer to the surgical end effector of the surgical
instrument and further away from the human or robotic operator of
the surgical instrument.
I. Exemplary Ultrasonic Surgical Instrument with Integrated RF
Energy
FIG. 1 illustrates an exemplary ultrasonic surgical instrument
(110). At least part of instrument (110) may be constructed and
operable in accordance with at least some of the teachings of U.S.
Pat. Nos. 5,322,055; 5,873,873; 5,980,510; 6,325,811; 6,773,444;
6,783,524; 8,461,744; 8,623,027; U.S. Pub. No. 2006/0079874, now
abandoned; U.S. Pub. No. 2007/0191713, now abandoned; U.S. Pub. No.
2007/0282333, now abandoned; U.S. Pub. No. 2008/0200940, now
abandoned; U.S. Pub. No. 2010/0069940, issued as U.S. Pat. No.
9,023,071 on May 5, 2015; U.S. Pub. No. 2012/0112687, issued as
U.S. Pat. No. 9,381,058 on Jul. 5, 2016; U.S. Pub. No.
2012/0116265, now abandoned; U.S. Pub. No. 2014/0005701, issued as
U.S. Pat. No. 9,393,037 on Jul. 19, 2016; U.S. Pub. No.
2014/0114334, issued as U.S. Pat. No. 9,095,367 on Aug. 4, 2015;
U.S. Pat. App. No. 61/410,603; and/or U.S. patent application Ser.
No. 14/028,717, issued as U.S. Pat. No. 10,172,636 on Jan. 8, 2019.
The disclosures of each of the foregoing patents, publications, and
applications are incorporated by reference herein. As described
therein and as will be described in greater detail below,
instrument (110) is operable to cut tissue and seal or weld tissue
(e.g., a blood vessel, etc.) substantially simultaneously. It
should also be understood that instrument (110) may have various
structural and functional similarities with the HARMONIC ACE.RTM.
Ultrasonic Shears, the HARMONIC WAVE.RTM. Ultrasonic Shears, the
HARMONIC FOCUS.RTM. Ultrasonic Shears, and/or the HARMONIC
SYNERGY.RTM. Ultrasonic Blades. Furthermore, instrument (110) may
have various structural and functional similarities with the
devices taught in any of the other references that are cited and
incorporated by reference herein.
To the extent that there is some degree of overlap between the
teachings of the references cited herein, the HARMONIC ACE.RTM.
Ultrasonic Shears, the HARMONIC WAVE.RTM. Ultrasonic Shears, the
HARMONIC FOCUS.RTM. Ultrasonic Shears, and/or the HARMONIC
SYNERGY.RTM. Ultrasonic Blades, and the following teachings
relating to instrument (110), there is no intent for any of the
description herein to be presumed as admitted prior art. Several
teachings herein will in fact go beyond the scope of the teachings
of the references cited herein and the HARMONIC ACE.RTM. Ultrasonic
Shears, the HARMONIC WAVE.RTM. Ultrasonic Shears, the HARMONIC
FOCUS.RTM. Ultrasonic Shears, and the HARMONIC SYNERGY.RTM.
Ultrasonic Blades.
Instrument (110) of the present example comprises a handle assembly
(120), a shaft assembly (130), and an end effector (140). Handle
assembly (120) comprises a body (122) including a pistol grip (124)
and a pair of buttons (125, 126). Handle assembly (120) also
includes a trigger (128) that is pivotable toward and away from
pistol grip (124). It should be understood, however, that various
other suitable configurations may be used, including but not
limited to a scissor grip configuration. End effector (140)
includes an ultrasonic blade (160) and a pivoting clamp arm (144).
Clamp arm (144) is coupled with trigger (128) such that clamp arm
(144) is pivotable toward ultrasonic blade (160) in response to
pivoting of trigger (128) toward pistol grip (124); and such that
clamp arm (144) is pivotable away from ultrasonic blade (160) in
response to pivoting of trigger (128) away from pistol grip (124).
Various suitable ways in which clamp arm (144) may be coupled with
trigger (128) will be apparent to those of ordinary skill in the
art in view of the teachings herein. In some versions, one or more
resilient members are used to bias clamp arm (144) and/or trigger
(128) to the open position shown in FIG. 1.
An ultrasonic transducer assembly (112) extends proximally from
body (122) of handle assembly (120) in the present example. In some
other versions, transducer assembly (112) is fully integrated
within body (122). Transducer assembly (112) receives electrical
power from generator (116) and converts that power into ultrasonic
vibrations through piezoelectric principles. Generator (116)
cooperates with a controller (118) to provide a power profile to
transducer assembly (112) that is particularly suited for the
generation of ultrasonic vibrations through transducer assembly
(112). While controller (118) is represented by a box that is
separate from generator (116) in FIG. 1, it should be understood
that controller (118) and generator (116) may be integrated
together in a single unit. By way of example only, generator (116)
may comprise a GEN04, GEN11, or GEN 300 sold by Ethicon
Endo-Surgery, Inc. of Cincinnati, Ohio. In addition or in the
alternative, generator (116) may be constructed in accordance with
at least some of the teachings of U.S. Pub. No. 2011/0087212,
entitled "Surgical Generator for Ultrasonic and Electrosurgical
Devices," published Apr. 14, 2011, issued as U.S. Pat. No.
8,986,302 on Mar. 24, 2015, the disclosure of which is incorporated
by reference herein. It should also be understood that at least
some of the functionality of generator (116) may be integrated into
handle assembly (120), and that handle assembly (120) may even
include a battery or other on-board power source such that cable
(114) is omitted. Still other suitable forms that generator (116)
may take, as well as various features and operabilities that
generator (116) may provide, will be apparent to those of ordinary
skill in the art in view of the teachings herein.
End effector (140) of the present example comprises clamp arm (144)
and ultrasonic blade (160). Clamp arm (144) includes a clamp pad
that is secured to the underside of clamp arm (144), facing blade
(160). By way of example only, the clamp pad may be formed of a
polytetrafluoroethylene (PTFE) material and/or any other suitable
material(s). By way of further example only, the clamp pad may be
further constructed and operable in accordance with at least some
of the teachings of U.S. Pat. No. 7,544,200, entitled "Combination
Tissue Pad for Use with an Ultrasonic Surgical Instrument," issued
Jun. 9, 2009, the disclosure of which is incorporated by reference
herein.
Clamp arm (144) is operable to selectively pivot toward and away
from blade (160) to selectively clamp tissue between clamp arm
(144) and blade (160) in response to pivoting of trigger (128)
toward pistol grip (124). Blade (160) of the present example is
operable to vibrate at ultrasonic frequencies in order to
effectively cut through and seal tissue, particularly when the
tissue is being clamped between clamp arm (144) and blade (160).
Blade (160) is positioned at the distal end of an acoustic
drivetrain that includes an acoustic waveguide (not shown) and
transducer assembly (112) to vibrate blade (160). By way of example
only, the acoustic waveguide and blade (160) may comprise
components sold under product codes SNGHK and SNGCB by Ethicon
Endo-Surgery, Inc. of Cincinnati, Ohio. By way of further example
only, the acoustic waveguide and blade (160) may be constructed and
operable in accordance with the teachings of U.S. Pat. No.
6,423,082, entitled "Ultrasonic Surgical Blade with Improved
Cutting and Coagulation Features," issued Jul. 23, 2002, the
disclosure of which is incorporated by reference herein. As another
merely illustrative example, the acoustic waveguide and blade (160)
may be constructed and operable in accordance with the teachings of
U.S. Pat. No. 5,324,299, entitled "Ultrasonic Scalpel Blade and
Methods of Application," issued Jun. 28, 1994, the disclosure of
which is incorporated by reference herein. Other suitable
properties and configurations that may be used for the acoustic
waveguide and blade (160) will be apparent to those of ordinary
skill in the art in view of the teachings herein.
In the present example, the distal end of blade (160) is located at
a position corresponding to an anti-node associated with resonant
ultrasonic vibrations communicated through a flexible acoustic
waveguide, in order to tune the acoustic assembly to a preferred
resonant frequency f.sub.o when the acoustic assembly is not loaded
by tissue. When transducer assembly (112) is energized, the distal
end of blade (160) is configured to move longitudinally in the
range of, for example, approximately 10 to 500 microns
peak-to-peak, and in some instances in the range of about 20 to
about 200 microns at a predetermined vibratory frequency f.sub.o
of, for example, 50 kHz or 55.5 kHz. When transducer assembly (112)
of the present example is activated, these mechanical oscillations
are transmitted through waveguides to reach blade (160), thereby
providing oscillation of blade (160) at the resonant ultrasonic
frequency. Thus, when tissue is secured between blade (160) and
clamp arm (144), the ultrasonic oscillation of blade (160) may
simultaneously sever the tissue and denature the proteins in
adjacent tissue cells, thereby providing a coagulative effect with
relatively little thermal spread. In some versions, an electrical
current may also be provided through blade (160) and clamp arm
(144) to also cauterize the tissue. For instance, blade (160) and
clamp arm (144) may be configured to apply radiofrequency (RF)
electrosurgical energy to tissue in addition to being configured to
apply ultrasonic energy to tissue.
End effector (140) of the present example is further operable to
apply radiofrequency (RF) electrosurgical energy to tissue that is
captured between clamp arm (144) and blade (160). By way of example
only, end effector (140) may include a single electrode that
cooperates with a conventional ground pad that is secured to the
patient, such that end effector (140) applies monopolar RF
electrosurgical energy to the tissue. As another merely
illustrative example, clamp arm (144) may include two electrodes
that are operable to apply bipolar RF electrosurgical energy to the
tissue. As yet another merely illustrative example, clamp arm (144)
may include a single electrode and ultrasonic blade (160) may serve
as a return path, such that ultrasonic blade (160) cooperates with
the electrode of clamp arm (144) to apply bipolar RF
electrosurgical energy to the tissue. In addition to or as an
alternative to the foregoing, end effector (140) may be constructed
and operable in accordance with at least some of the teachings of
U.S. Pat. No. 8,663,220, entitled "Ultrasonic Electrosurgical
Instruments," issued Mar. 4, 2014, the disclosure of which is
incorporated by reference herein. Other suitable arrangements will
be apparent to those of ordinary skill in the art in view of the
teachings herein.
Instrument (110) may provide the operator with various ways in
which to selectively apply only ultrasonic energy to tissue via end
effector (140), only RF electrosurgical energy to tissue via end
effector (140), or some combination of ultrasonic energy and RF
electrosurgical energy to tissue via end effector (140). In
versions where end effector (140) is operable to apply a
combination of ultrasonic energy and RF electrosurgical energy to
tissue, end effector (140) may be configured to apply ultrasonic
energy and RF electrosurgical energy to tissue simultaneously. In
addition or in the alternative, in versions where end effector
(140) is operable to apply a combination of ultrasonic energy and
RF electrosurgical energy to tissue, end effector (140) may be
configured to apply ultrasonic energy and RF electrosurgical energy
to tissue in a sequence. Such a sequence may be predetermined; or
may be based on sensed tissue conditions (e.g., tissue temperature,
density, thickness, etc.). Various suitable control algorithms that
may be used are disclosed in U.S. Pub. No. 2015/0141981, entitled
"Ultrasonic Surgical Instrument with Electrosurgical Feature,"
published May 21, 2015, issued as U.S. Pat. No. 9,949,785 on Apr.
24, 2018, the disclosure of which is incorporated by reference
herein. It should also be understood that the control of ultrasonic
energy and RF electrosurgical energy may be provided in accordance
with at least some of the teachings of U.S. Pat. No. 8,663,220,
entitled "Ultrasonic Electrosurgical Instruments," issued Mar. 4,
2014, the disclosure of which is incorporated by reference
herein.
Buttons (125, 126) may provide the operator with varied control of
the energy that is applied to tissue through end effector (140).
For instance, in some versions, button (125) may be activated to
apply RF electrosurgical energy to tissue; while button (126) may
be activated to apply ultrasonic energy to tissue. As another
merely illustrative example, button (125) may be activated to apply
ultrasonic energy to tissue at a low power level (e.g., without
also applying RF electrosurgical energy to tissue, applying RF
electrosurgical energy to tissue simultaneously, or applying RF
electrosurgical energy to tissue in a sequence with the ultrasonic
energy); while button (126) may be activated to apply ultrasonic
energy to tissue at a high power level (e.g., without also applying
RF electrosurgical energy to tissue, applying RF electrosurgical
energy to tissue simultaneously, or applying RF electrosurgical
energy to tissue in a sequence with the ultrasonic energy). In
addition or in the alternative, buttons (125, 126) may provide
functionality in accordance with at least some of the teachings of
U.S. Pub. No. 2015/0141981, entitled "Ultrasonic Surgical
Instrument with Electrosurgical Feature," published May 21, 2015,
issued as U.S. Pat. No. 9,949,785 on Apr. 24, 2018, the disclosure
of which is incorporated by reference herein. Other suitable ways
in which buttons (125, 126) may provide operation of instrument
(110) will be apparent to those of ordinary skill in the art in
view of the teachings herein.
II. Exemplary End Effector Configurations
As noted above, end effector (140) may include various kinds of
electrode configurations to apply RF electrosurgical energy to
tissue. It should also be understood that ultrasonic blade (160)
may have various structural configurations. These various
structural configurations of ultrasonic blade (160) may provide
different kinds of effects on tissue. In particular, the particular
structural configuration of ultrasonic blade (160) may influence
the way in which ultrasonic blade (160) applies ultrasonic energy
to tissue. For instance, some ultrasonic blade (160) configurations
may provide better ultrasonic cutting of tissue while other
ultrasonic blade (160) configurations may provide better ultrasonic
sealing of tissue. The relationships between the structural
configurations of the electrode(s) and ultrasonic blade (160) may
also influence the way in which end effector (140) applies RF
electrosurgical energy to tissue. The following discussion provides
various examples of different end effector configurations. It
should be understood that any of the various end effectors
described below may be readily incorporated into instrument (110),
in place of end effector (140).
It should also be understood that all of the end effectors
described below may include features that are configured to ensure
that a minimum gap is defined between the variation of clamp arm
(144) and the variation of blade (160), even when the variation of
end effector (140) is in a fully closed configuration. Such a
minimum gap will prevent the variation of clamp arm (144) from
contacting the variation of blade (160), which will prevent
formation of a short circuit between an electrode of the variation
of clamp arm (144) and the variation of blade (160). This may be
particularly important when the variation of end effector is being
used to provide bipolar RF electrosurgical energy to tissue, with
the electrode of the variation of clamp arm (144) providing one
pole for the RF electrosurgical energy and the variation of blade
(160) providing the other pole for the RF electrosurgical energy. A
minimum gap may also selected to prevent arcing of such energy,
where the arcing might otherwise occur when a gap is sized below
the predetermined minimum amount. By way of example only, a minimum
gap may be provided in accordance with at least some of the
teachings of U.S. patent application Ser. No. 14/928,375, entitled
"Ultrasonic Surgical Instrument Clamp Arm with Proximal Nodal Pad,"
filed Oct. 30, 2015, issued as U.S. Pat. No. 10, 028,765 on Jul.
24, 2018, the disclosure of which is incorporated by reference
herein. Other suitable ways in which a minimum gap may be provided
will be apparent to those of ordinary skill in the art in view of
the teachings herein.
A. End Effector with Dual Electrode Insert within Clamp Pad
FIGS. 2-7 show portions of other exemplary end effectors that may
be readily incorporated into instrument (110) in place of end
effector (140). More specifically, FIG. 2 shows a clamp arm
assembly (6001) of end effector (6000) shown in FIG. 3. In the
present example, a blade of end effector (6000) is the same as
blade (240) as described above, while other blade configurations
may be used in other examples. End effector (6000) further
comprises a clamp arm (6010), a clamp pad (6020), a clamp pad
retainer member (6030), a first electrode (6060), and a second
electrode (6061).
Clamp arm (6010) is configured with multiple bores (6011) that
align with corresponding bores (6021) of clamp pad (6020) and
corresponding bores (6031) of retainer member (6030). Clamp arm
(6010) comprises an opening (6012) that is shaped to receive clamp
pad (6020), which is formed with corresponding features that are
shaped to fit within opening (6012). Similarly, retainer member
(6030) is formed with features that are shaped to engage with
corresponding features of clamp arm (6010). For example, retainer
member (6030) includes a rail (6032) similar to rail (226)
described above, with rail (6032) engaging a recess within clamp
arm (6010) that is shaped to receive rail (6032). With clamp pad
(6020) and retainer member (6030) positioned within clamp arm
(6010), multiple pins may be used to secure clamp pad (6020) and
retainer member (6030) to clamp arm (6010) by inserting the pins
through the aligning bores (6011, 6021, 6031). By way of example
only, this method of assembly could be achieved by overmolding
clamp pad (6020) and retainer member (6030) to clamp arm (6010)
while capturing electrodes (6060, 6061).
First electrode (6060) comprises a pair of contacts or terminals
(6062), while second electrode (6061) also comprises a pair of
contacts or terminals (6063). In some other versions, the pair of
contacts may be modified or replaced such that each electrode
(6060, 6061) comprises only a single contact or terminal. First and
second electrodes (6060, 6061) also comprise respective body
portions (6064, 6065). The pairs of terminals (6062, 6063) extend
from their respective body portions (6064, 6065) in a manner such
that pairs of terminals (6062, 6063) are generally orthogonal with
respect to their respective body portions (6064, 6065).
Referring now also to FIGS. 3 and 4, in the connection with clamp
arm assembly (6001), first electrode (6060) is received within
clamp pad (6020), with pair of terminals (6062) extending through
clamp pad (6020) such that pair of terminals (6062) are exposed and
accessible from a top outer region of clamp arm (6010) as seen in
FIG. 2. Second electrode (6061) connects with clamp arm assembly
(6001) in the same manner as first electrode (6060). To accommodate
first and second electrodes (6060, 6061), clamp pad (6020)
comprises a pair of longitudinal slots (6022) for receiving body
portions (6064, 6065) of electrodes (6060, 6061). Clamp pad (6020)
also comprises bores (6023) that allow pairs of terminals (6062,
6063) of electrodes (6060, 6061) to pass through clamp pad (6020)
for access from the top outer region of clamp arm (6010). In some
other versions, these exposed terminals (6062, 6063) bend
90.degree. and terminate into the proximal end of clamp pad (6020);
and connect to an insulated wire.
Referring to FIGS. 4 and 5, clamp pad (6020) comprises teeth (6025)
as described above. As also described above, end effector (6000) is
configured for tissue engagement between blade (240) and the
toothed surface of clamp pad (6020). Clamp pad (6020) remains proud
relative to the surfaces of electrodes (6060, 6061), such that the
surfaces of electrodes (6060, 6061) are recessed relative to the
tissue engaging toothed surface of clamp pad (6020). In those
regions with longitudinal slots (6022), when tissue is held between
clamp pad (6020) and blade (240), tissue can at least partially
fill slots (6022) contacting electrodes (6060, 6061). In this
manner, a conductive pathway is established through the tissue
between electrodes (6060, 6061) and blade (240). Blade (240) is
aligned with a centerline region (6024) of clamp pad (6020) that
extends between first and second electrodes (6060, 6061). With
tissue compressed between clamp pad (6020) and blade (240),
ultrasonic energy can be imparted to waveguide (242) and thereby
ultrasonically sever the tissue along the continuous centerline
region (6024) of clamp pad (6020). On each side of the cut line,
ultrasonic sealing occurs as described above. In addition, end
effector (6000) is further operable to provide RF electrosurgical
sealing of tissue along the conductive pathways described above,
which would include tissue that is laterally outward from the cut
line formed between upper surface (252) of blade (240) and
centerline region (6024) of clamp pad (6020). With the continuously
exposed electrodes (6060, 6061) along a majority of the length of
clamp pad (6020), RF electrosurgical sealing may be obtained along
each side of the length of the tissue cut line.
Referring to FIGS. 6 and 7, in other versions, RF electrosurgical
sealing is not required to be continuous along each side of the cut
line, and instead may occur at multiple points along each side of
the cut line in a discontinuous fashion. As shown in FIG. 6, clamp
pad (6120) may replace clamp pad (6020). Clamp pad (6120) comprises
transverse oval shaped openings (6122) as opposed to longitudinal
slots (6022) of clamp pad (6020). Openings (6122) extend across
centerline region (6124) of clamp pad (6120) such that centerline
region (6124) of clamp pad (6120) is not continuous pad material
along the length of centerline region (6124) as opposed to the
configuration with clamp pad (6020) having continuous centerline
region (6024).
In the example shown in FIGS. 6 and 7, ultrasonic energy may be
provided to sever the tissue along a cut line that coincides with
the aligned upper surface (252) of blade (240) and centerline
region (6124) of clamp pad (6120). In the present configuration
clamp pad (6120) contacts gripped tissue intermittently or in a
discontinuous fashion because openings (6122) interrupt centerline
region (6124). However, the spacing of openings (6122) and the
ultrasonic energy applied are configured such that a continuous cut
of the tissue is made over the length of clamp pad (6120) even
without continuous contact between clamp pad (6120) and the tissue
along centerline region (6124).
Openings (6122) in clamp pad (6120) provide access to or expose
electrodes (6060, 6061). With this configuration, when the tissue
is compressed between blade (240) and clamp pad (6120), the tissue
can at least partially fill openings (6122) to contact electrodes
(6060, 6061) at locations along the length of clamp pad (6120). In
this manner, a conductive pathway is established through the tissue
between electrodes (6060, 6061) and blade (240). With the tissue
compressed between clamp pad (6120) and blade (240), ultrasonic
energy can be imparted to waveguide (242) and thereby
ultrasonically sever the tissue along the length of clamp pad
(6120) as discussed above. On each side of the cut line, ultrasonic
sealing occurs as described above. In addition, the end effector
with clamp pad (6120) is further operable to provide RF
electrosurgical sealing of tissue along the conductive pathways
described above, which would include tissue that is laterally
outward from the cut line formed between upper surface (252) of
blade (240) and centerline region (6124) of clamp pad (6120). In
some versions using openings (6122) the RF electrosurgical sealing
occurs at those locations on each side of the cut line
corresponding to the locations of respective openings (6122). In
some versions, the spacing of openings (6122) is such that the RF
electrosurgical sealing occurs not only at the openings (6122), but
between openings (6122) as well. In this manner, RF electrosurgical
sealing may be obtained along the length of clamp pad (6120) and
thus along each side of the length of the tissue cut line. In view
of the teachings herein, other configurations for openings (6122)
to provide RF electrosurgical sealing will be apparent to those of
ordinary skill in the art.
In the examples discussed above with respect to FIGS. 2-7, pairs of
terminals (6062, 6063) connect to an electrical source such that
each electrode (6060, 6061) has the same polarity, with blade (240)
having the opposite polarity such that the conductive pathways
exist between each of electrodes (6060, 6061) and blade (240). In
other versions, blade (240) is electrically neutral and electrode
(6060) has an opposite polarity to electrode (6061). In such
examples with two oppositely polarized electrodes (6060, 6061) and
a neutral blade (240), pairs of terminals (6062, 6063) connect to
electrical sources such that one of electrodes (6060, 6061) has
positive polarity and the other has negative polarity. With this
configuration, the conductive pathways are established through the
tissue between electrodes (6060, 6061). With these conductive
pathways, the RF electrosurgical sealing occurs laterally across
the tissue cut line. In versions using clamp pad (6020), the RF
electrosurgical sealing may be continuous along the length of clamp
pad (6020) and the tissue cut line. In versions using clamp pad
(6120), the RF electrosurgical sealing may be discontinuous along
the length of clamp pad (6120) and the tissue cut line. In view of
the teachings herein, other ways to configure electrodes (6060,
6061) and clamp pads (6020, 6120) to achieve a desired conductive
pathway for RF electrosurgical sealing will be apparent to those of
ordinary skill in the art.
B. End Effector with Dual Electrode Molded within Clamp Pad
FIGS. 8A-9B show exemplary end effectors (7000, 7100) that may be
readily incorporated into instrument (110) in place of end effector
(140). FIGS. 8A and 8B show end effector (7000), which comprises
clamp arm (210), a clamp pad (7020), blade (240), and first and
second wires (7060, 7061). FIG. 8A shows a first state of
manufacture for end effector (7000), prior to machining clamp pad
(7020). FIG. 8B shows a second state of manufacture for end
effector (7000), after machining clamp pad (7020) to expose
electrodes (7062, 7063) within wires (7060, 7061), which have an
insulating material surrounding electrodes (7062, 7063). In the
present example, clamp pad (7020) is formed in a molding process
such that clamp pad (7020) is formed with clamp arm (210) and
molded over wires (7060, 7061). In other examples, clamp pad (7020)
may be formed separate from clamp arm (210) and/or wires (7060,
7061) and then later combined with clamp arm (210) and/or wires
(7060, 7061). After combining wires (7060, 7061), clamp pad (7020),
and clamp arm (210), clamp pad (7020) is machined such that
portions of clamp pad (7020) are cut away along with insulator
portions of wires (7060, 7061) to expose electrodes (7062, 7063).
In some instances, it is not necessary to combine clamp pad (7020)
and wires (7060, 7061) with clamp arm (210) prior to machining
assembled clamp pad (7020) and wires (7060, 7061).
In the present example, each of wires (7060, 7061) have the same
polarity with blade (240) having the opposite polarity. With
identically polarized wires (7060, 7061) positioned opposite to
oppositely polarized blade (240), this can be considered an
opposing or offset electrode configuration. In some versions, wires
(7060, 7061) each serve as a positive pole while blade (240) serves
as a negative pole. In this configuration the conductive pathway is
created through tissue between wires (7060, 7061) and blade (240).
It should also be understood that, in some other versions, wires
(7060, 7061) may have opposing polarity while blade (240) is
electrically neutral.
Furthermore, as will be apparent to those of ordinary skill in the
art in view of the teachings herein, the configuration of the
machined cutouts, and the resulting openings created in clamp pad
(7020) to expose electrodes (7062, 7063) will impact the
configuration of the conductive pathways and the resulting RF
electrosurgical sealing. By way of example only, and not
limitation, clamp pad (7020) and wires (7060, 7061) may be machined
such that there are continuous openings along clamp pad (7020)
exposing electrodes (7062, 7063) in a continuous fashion along the
length of clamp pad (7020). In other versions, clamp pad (7020) and
wires (7060, 7061) may be machined such that there are intermittent
openings along clamp pad (7020) exposing electrodes (7062, 7063)
intermittently along the length of clamp pad (7020). In either
approach, clamp pad (7020) and blade (240) are configured such that
after machining clamp pad (7020), a sufficient gap is maintained
between electrodes (7062, 7063) and blade (240) to prevent short
circuiting as discussed above. In use, ultrasonic cutting,
ultrasonic sealing, and RF electrosurgical sealing occur in the
same or similar manner as described above and will be apparent to
those of ordinary skill in the art in view of the teachings
herein.
FIGS. 9A and 9B show end effector (7100), which comprises clamp arm
(210), a clamp pad (7120), blade (240), and first and second wires
(7060, 7061). FIG. 9A shows a first state of manufacture for end
effector (7100), prior to machining clamp pad (7120). FIG. 9B shows
a second state of manufacture for end effector (7100), after
machining clamp pad (7120) to expose electrodes (7062, 7063) within
wires (7060, 7061), which have an insulating material surrounding
electrodes (7062, 7063). In the present example, clamp pad (7120)
is formed in a molding process such that clamp pad (7120) is formed
with clamp arm (210) and molded over wires (7060, 7061). In other
examples, clamp pad (7120) may be formed separate from clamp arm
(210) and/or wires (7060, 7061) and then later combined with clamp
arm (210) and/or wires (7060, 7061). After combining wires (7060,
7061), clamp pad (7120), and clamp arm (210), clamp pad (7120) is
machined such that portions of clamp pad (7120) are cut away along
with insulator portions of wires (7060, 7061) to expose electrodes
(7062, 7063). In some instances, it is not necessary to combine
clamp pad (7120) and wires (7060, 7061) with clamp arm (210) prior
to machining assembled clamp pad (7120) and wires (7060, 7061).
In the present example, each wire (7060, 7061) has an opposite
polarity with blade (240) being neutral. With oppositely polarized
wires (7060, 7061) positioned offset from one another within clamp
pad (7120), this can be considered an offset electrode
configuration. In a configuration where wire (7060) serves as a
positive pole and wire (7061) serves as a negative pole, the
conductive pathway is created from electrode (7062) of wire (7060),
through the gripped tissue, and to electrode (7063) of wire (7061).
To facilitate this conductive pathway, wires (7060, 7061) are
positioned closer together compared to the arrangement shown in
FIGS. 8A and 8B. In view of the teachings herein, other positions
for wires (7060, 7061) relative to clamp pad (7120) to achieve a
desired conductive pathway through tissue will be apparent to those
of ordinary skill in the art. It should also be understood that end
effector (7100) may be modified such that electrodes (7062, 7063)
both provide one pole (e.g., a positive pole) while blade (240)
provides an opposite pole (e.g., a negative pole).
Furthermore, as will be apparent to those of ordinary skill in the
art in view of the teachings herein, the configuration of the
machined cutouts, and the resulting openings created in clamp pad
(7120) to expose electrodes (7062, 7063) will impact the
configuration of the conductive pathways and the resulting RF
electrosurgical sealing. By way of example only, and not
limitation, clamp pad (7120) and wires (7060, 7061) may be machined
such that there are continuous openings along clamp pad (7120)
exposing electrodes (7062, 7063) in a continuous fashion along the
length of clamp pad (7120). In other versions, clamp pad (7120) and
wires (7060, 7061) may be machined such that there are intermittent
openings along clamp pad (7120) exposing electrodes (7062, 7063)
intermittently along the length of clamp pad (7120). In either
approach, although blade (240) is neutral, clamp pad (7120) and
blade (240) may be configured such that after machining clamp pad
(7120), a sufficient gap is maintained between electrodes (7062,
7063) and blade (240) to prevent short circuiting as discussed
above. In use, ultrasonic cutting, ultrasonic sealing, and RF
electrosurgical sealing occur in the same or similar manner as
described above and will be apparent to those of ordinary skill in
the art in view of the teachings herein. Furthermore, in some
versions end effector (7100) may be configured such that electrodes
(7062, 7063) have the same polarity and are used with blade (240)
having an opposite polarity, similar to the description above with
respect to end effector (7000).
C. End Effector with Dual Nested Electrode within Clamp Pad
FIGS. 10-15B show clamp assemblies (8001, 8101, 8201) of three
other exemplary end effectors that may be readily incorporated into
instrument (110) in place of end effector (140). Each end effector
of these examples comprises the same clamp arm (8010), clamp pad
retainer member (8030), wires (8040, 8041), insulators (8050,
8051), electrodes (8060, 8061), and blade (240). However, each end
effector of these examples comprises a different configuration for
clamp pads (8020, 8120, 8220) as will be described in greater
detail below.
Referring to FIGS. 10 and 12-13B, the end effector of this example
comprises a clamp arm assembly (8001). Clamp arm assembly (8001) is
operable to pivot toward and away from blade (240) in the manner
described above. Clamp arm assembly (8001) comprises clamp arm
(8010), clamp pad (8020), clamp pad retainer member (8030), wires
(8040, 8041), insulators (8050, 8051), and electrodes (8060, 8061).
Clamp pad retainer member (8030) operates similar to clamp pad
retainer member (230) discussed above. Clamp pad (8020) comprises
openings (8021) that provide access to electrodes (8060, 8061). In
the present example, openings (8021) are configured as rectangular
shapes, where openings (8021) extend laterally across clamp pad
(8020). This configuration provides for a centerline region (8027)
of clamp pad (8020) with electrodes (8060, 8061) partially
accessible or exposed. In the present example, blade (240) aligns
along centerline region (8027) such that when tissue is compressed
between blade (240) and clamp pad (8020), ultrasonic energy may be
provided to sever the tissue along a cut line that coincides with
the aligned upper surface (252) of blade (240) and centerline
region (8027) of clamp pad (8020). In the present configuration
clamp pad (8020) provides intermittent contact with the tissue
along centerline region (8027) when the end effector is in a closed
configuration gripping the tissue because openings (8021) interrupt
centerline region (8027).
Openings (8021) in clamp pad (8020) provide access to or expose
electrodes (8060, 8061). Electrodes (8060, 8061) each comprise
projections (8062, 8063) that extend from respective body portions
(8064, 8065) of electrodes (8060, 8061). Furthermore, electrodes
(8060, 8061) each comprise spaces (8066, 8067) between respective
projections (8062, 8063) of electrodes (8060, 8061). Projections
(8062) and spaces (8066) are offset along the length of electrode
(8060) relative to projections (8063) and spaces (8067) of
electrode (8061). With this offset configuration, electrodes (8060,
8061) have a nested, interdigitated arrangement as best seen in
FIG. 12, where projections (8062) are positionable within spaces
(8067), and projections (8063) are positionable within spaces
(8066). As seen in FIG. 12, although nested, electrodes (8060,
8061) maintain a space or gap from one another such that they are
not in contact. Electrodes (8060, 8061) are connectable with wires
(8040, 8041) such that electrodes (8060, 8061) can serve as
positive and negative poles. While wires (8040, 8041) are shown as
being exposed above clamp arm (8010) in FIGS. 10-12, 13B, 14B, and
15B, it should be understood that this is an exaggerated
representation of wires (8040, 8041). In practical contexts, wires
(8040, 8041) may in fact be disposed in clamp pad (8020) and
retainer member (8030) such that wires (8040, 8041) are not exposed
above clamp arm (8010).
Insulators (8050, 8051) are positioned between clamp arm (8010) and
electrodes (8060, 8061) such that clamp arm (8010) remains
electrically neutral. In the present example, blade (240) can be
coated such that blade (240) remains electrically neutral also. The
coating used with blade (240) can also provide non-stick features
that help prevent tissue from sticking to blade (240).
With this configuration, when the tissue is compressed between
blade (240) and clamp pad (8020), the tissue can at least partially
fill openings (8021) to contact electrodes (8060, 8061) at
locations along the length of clamp pad (8020). Moreover, at least
some of the tissue that fills openings (8021) can at least
partially fill spaces (8066, 8067) between electrodes (8060, 8061).
In this manner, a conductive pathway is established through the
tissue between electrodes (8060, 8061). With the tissue compressed
between clamp pad (8020) and blade (240), ultrasonic energy can be
imparted to waveguide (242) and thereby ultrasonically sever the
tissue along the length of clamp pad (8020) as discussed above. On
each side of the cut line, ultrasonic sealing occurs as described
above. In addition, the end effector is further operable to provide
RF electrosurgical sealing of the tissue along the conductive
pathways described above, which would include RF electrosurgical
sealing through tissue from one side of the cut line to tissue on
the other side of the cut line since the cut line is generally
centered along the nested area of electrodes (8060, 8061). In some
versions, the spacing of openings (8021) is such that the RF
electrosurgical sealing occurs not only at the openings (8021), but
between openings (8021) as well. In this manner, RF electrosurgical
sealing may be obtained along the entire length of clamp pad (8020)
and thus the entire length of the tissue cut line. In other
versions, RF electrosurgical sealing is not required to be
continuous along the cut line, and instead may occur at multiple
points along the cut line in a discontinuous fashion as described
above.
In some other versions using an end effector as configured as shown
in FIGS. 10 and 12-13B, the end effector may be modified such that
each electrode (8060, 8061) has the same polarity and with the
blade (240) having the opposite polarity from the electrodes (8060,
8061). In this configuration, and where the electrodes (8060, 8061)
serve as positive poles and blade (240) serves as the negative
pole, the conductive path will extend from each of the electrodes
(8060, 8061), through the tissue, and to the blade (240). As will
be understood by those of ordinary skill in the art in view of the
teachings herein, the RF electrosurgical sealing will then occur as
described above with respect to those versions using a polarized
blade.
FIGS. 11, 14A, and 14B show a similar end effector that uses clamp
arm assembly (8101), which incorporates clamp pad (8120). As
mentioned above, clamp arm assembly (8101) includes many of the
same components and operates similarly to clamp arm assembly (8001)
described above. One difference is with clamp arm assembly (8101),
clamp pad (8120) is formed with a rail (8126) for engaging with
clamp arm (8010). Rail (8126) is structurally and operably similar
to rail (226) described above. Another difference with clamp arm
assembly (8101) is that clamp pad (8120) comprises openings (8121)
that are shaped as pairs of longitudinally elongated circles that
repeat along the length of clamp pad (8120). With this alternate
opening configuration for clamp pad (8120), the pattern of the RF
electrosurgical sealing may differ from that described above with
respect to clamp pad (8020) and openings (8021). As described
above, this end effector using clamp arm assembly (8101) may be
configured such that an electrically neutral blade (240) is used
with oppositely polarized electrodes (8060, 8061); or in other
versions each electrode (8060, 8061) may have the same polarity,
with blade (240) being oppositely polarized. The gap between
openings (8121) may vary to ensure there is material to engage
blade (240) for the ultrasonic functionality. For instance, distal
openings (8121) may be smaller out at the tapered end of clamp arm
(8010). Alternatively, blade (240) may be reconfigured to contact
outside of the centerline to allow a cut along the entire length of
clamp arm (8010).
FIGS. 15A and 15B show a similar end effector that uses clamp arm
assembly (8201), which incorporates clamp pad (8220). As mentioned
above, clamp arm assembly (8201) includes many of the same
components and operates similarly to clamp arm assembly (8001)
described above. One difference with clamp arm assembly (8201) is
that clamp pad (8220) is formed with a rail (8226) for engaging
with clamp arm (8010). Rail (8226) is structurally and operably
similar to rail (226) described above. Another difference with
clamp arm assembly (8201) is that clamp pad (8220) comprises
openings (8221) that are shaped as pairs of circles that repeat
along the length of clamp pad (8220). With this alternate opening
configuration for clamp pad (8220), the pattern of the RF
electrosurgical sealing may differ from that described above with
respect to clamp pad (8020) and openings (8021). As described
above, this end effector using clamp arm assembly (8201) may be
configured such that an electrically neutral blade (240) is used
with oppositely polarized electrodes (8060, 8061); or in other
versions each electrode (8060, 8061) may have the same polarity
with blade (240) being oppositely polarized.
While the above version illustrate electrodes (8060, 8061) as flat
conductors, such as stamped metal, etc., in some other versions
electrodes (8060, 8061) can be wire structures. For example, a pair
of wires may be configured in a close nested arrangement, similar
to the nested arrangement shown for electrodes (8060, 8061) in FIG.
12. The wires may then have opposite polarity and be used with a
neutral blade (240) or the wires may have the same polarity and be
used with an oppositely polarized blade (240) as described above.
In view of the teachings herein, other nested structures and
arrangements for electrodes (8060, 8061) will be apparent to those
of ordinary skill in the art.
D. End Effector with Split Clamp Arm Electrodes
FIGS. 16-20B show another exemplary end effector (2100) that may be
readily incorporated into instrument (110) in place of end effector
(140). End effector (2100) comprises a clamp arm (2110), blade
(240), and a pad (2120). Clamp arm (2110) has a split configuration
where clamp arm (2110) comprises a first body (2111) and a second
body (2112). As will be discussed further below, first body (2111)
and second body (2112) each have opposite polarity and serve as
electrodes for RF electrosurgical sealing.
Positioned between first body (2111) and second body (2112) of
clamp arm (2110) is an electrically insulating clamp pad (2120). In
the present example, clamp pad (2120) is molded and formed between
first and second bodies (2111, 2112). First body (2111) comprises
bores (2113) that are configured to receive portions of molded
clamp pad (2120) to secure clamp pad (2120) with first body (2111).
Similarly, second body (2112) comprises bores (2114) that are also
configured to receive portions of molded clamp pad (2120) to secure
clamp pad (2120) with first body (2111). As shown in FIG. 19,
molded clamp pad (2120) extends within bores (2113, 2114),
connecting first body (2111) and second body (2112) together.
Collectively, first body (2111), second body (2112), and clamp pad
(2120) make up clamp arm assembly (2101). While the present example
shows bores (2113) and bores (2114) generally aligned across from
each other, such alignment is not required in all versions. In
assembling clamp arm (2110), clamp pad (2120) is formed between
first body (2111) and second body (2112) such that first body
(2111) and second body (2112) do not directly contact one another.
In this manner, with first body (2111) oppositely polarized from
second body (2112), short circuits can be avoided. In view of the
teachings herein, other ways to configure clamp arm (2110) and
clamp pad (2120) to achieve a multi part clamp arm that provides
both positive and negative polarity will be apparent to those of
ordinary skill in the art.
In the present example, clamp arm assembly (2101) connects with
inner tube (204) and outer tube (202). Clamp arm assembly (2101) is
operable to open and close to grip tissue in the same manner to
that described above with respect to end effector (200). In the
present example, first body (2111) makes connects with outer tube
(202) by way of a post (2115) engaging an opening (208) in outer
tube (202). Post (2115) is directly formed as part of first body
(2111) such that post (2115) provides a path for electrical
communication between outer tube (202) and first body (2111).
Second body (2112) connects with inner tube (204) by way of a pin
(2116) engaging an opening (209) in inner tube (204). Pin (2116)
extends through an opening (2118) in second body (2112), which
aligns with opening (209) in inner tube (204). Pin (2116) is
comprised of a conductive material such that pin (2116) provides a
path for electrical communication between inner tube (204) and
second body (2112).
To provide electrical isolation between outer tube (202) and inner
tube (204), first body (2111) does not directly connect with inner
tube (204). Instead, pin (2116) extends through a molded bore
(2121) in clamp pad (2120), which is securely attached with first
body (2111) as described above. Similarly, second body (2112) does
not directly connect with outer tube (202), but instead clamp pad
(2120) is formed with a post (2122) that engages an opening (207)
in outer tube (202). With this configuration, clamp arm assembly
(2101) has a pivoting connection with inner tube (204) as well as a
pivoting connection with outer tube (202) such that clamp arm
assembly (2101) is operable to open and close in response to
translating movement of outer and/or inner tubes (202, 204) as
described above. Moreover, clamp arm assembly (2101) is operable to
open and close while maintaining two sides of clamp arm (2110)
having opposite polarity. In view of the teachings herein, other
ways to connect clamp arm assembly (2101) with inner and outer
tubes (204, 202) for open/close operability, while maintaining the
polarity configuration descried above, will be apparent to those of
ordinary skill in the art.
Referring to FIG. 19, with its split configuration, clamp arm
(2110) includes a split U-shaped electrode surface (2117) formed by
first and second bodies (2111, 2112). Clamp pad (2120) includes a
plurality of teeth (2123) that assist in gripping tissue that is
clamped between clamp arm (2110) and blade (240). Electrode surface
(2117) extends around clamp arm (2110), surrounding the outer
perimeter of clamp pad (2120) except where clamp pad (2120)
separates first body (2111) from second body (2112) at the
distal-most end of clamp arm (2110). In the present example,
electrode surface (2117) is flush with the ridges of teeth (2123),
such that valleys of teeth (2123) are recessed relative to
electrode surface (2117). In some alternative versions, the ridges
of teeth (2123) are recessed relative to electrode surface (2117).
In some other alternative versions, the ridges of teeth (2123) are
proud relative to electrode surface (2117), such that electrode
surface is recessed relative to the ridges of teeth (2123). Other
suitable relationships will be apparent to those of ordinary skill
in the art in view of the teachings herein.
End effector (2100) may capture a single layer of tissue or two or
more layers of tissue may be captured in some examples. As
similarly described above with respect to end effector (200), the
compression forces on the tissue with end effector (2100) are
focused in the region between upper contact surface (252) of blade
(240) and clamp pad (2120). These compression forces are directed
mainly along the same vertical plane along which clamp arm (2110)
pivots toward blade (240). The tissue is also contacted by oblique
surfaces (254) of blade (240). However, the compression provided by
oblique surfaces (254) is lower than the compression provided by
upper contact surface (252). Moreover, the compression forces
imposed on the tissue by oblique surfaces (254) are directed
obliquely outwardly, mainly toward electrode surface (2117). It
should be understood that the above-described manner in which end
effector (2100) engages tissue may provide ultrasonic severing of
tissue in the region between upper contact surface (252) and clamp
pad (2120); with combined ultrasonic sealing of tissue in the
regions between oblique surfaces (254) and clamp pad (2120) and/or
electrode surface (2117).
Additionally, with oppositely polarized first body (2111) and
second body (2112) of clamp arm (2110), when end effector (2100)
captures tissue in a closed configuration, a conductive pathway is
created between the positive pole of e.g. first body (2111),
laterally through the captured tissue, and the negative pole of
e.g. second body (2112). Of course in other versions the polarity
of first and second bodies (2111, 2112) may be switched such that
the conductive pathway would be similar but flow from second body
(2112), through the tissue, and to first body (2111). In the
present example, RF electrosurgical sealing occurs along the
conductive pathway described above, which includes RF
electrosurgical sealing laterally through the compresses tissue
along and across the cut line of the tissue. In this example, blade
(240) may be neutral or blade (240) may be electrically
conductive.
E. End Effector with Clamp Pad Flow Control
FIGS. 21-23 show other exemplary end effectors (2800, 2900) that
may be readily incorporated into instrument (110) in place of end
effector (140). End effectors (2800, 2900) include clamp pads and
clamp arms. There may be concern that, as the clamp pad material
wears, there will be need to be a path for the clamp pad material
to flow. Thus, the clamp pads of the following examples include
features that guide flow of the clamp pad material when degradation
occurs so that this clamp pad flow will not interfere with the
consistent gap desired between electrode poles of respective end
effectors (2800, 2900). A consistent gap between electrode poles
promotes consistent RF electrosurgical sealing.
Referring to FIGS. 21-22C, end effector (2800) comprises clamp arm
(2810), clamp pad (2820), and blade (2840). In the present example,
blade (2840) has serves as a negative pole and thereby serves as
one of the electrodes for RF electrosurgical sealing. Furthermore,
clamp arm (2810) serves as a positive pole and thereby serves as
the other electrode for RF electrosurgical sealing. End effector
(2800) is configured initially with a desired gap between the
electrodes--in the present example, between blade (2840) and clamp
arm (2810). Similarly to previously described end effector
versions, end effector (2800) is operable to capture,
ultrasonically sever, ultrasonically seal, and RF electrosurgical
seal tissue that is compressed between blade (2840) and clamp pad
(2820). These processes can create a heat build-up that can deform
clamp pad (2820). This deformation can cause clamp pad (2820) to
flow outwardly away from areas of compression with blade (2820).
Deformed portions of clamp pad (2820), can move out laterally where
there are not electrodes protruding downwardly from clamp arm
(2810). This deformation, flow, and deposit of clamp pad material
can alter the desired initial gap between the electrodes--in the
present example, between blade (2840) and clamp arm (2810).
With end effector (2800), clamp arm (2810) comprises electrodes
(2812) along its perimeter such that clamp arm (2810) has a
castellated appearance as shown in FIG. 21. Clamp pad (2820) is
formed within electrodes (2812) of clamp arm (2810) as seen by
comparing the cross-section views of FIGS. 22A and 22B. With this
configuration, when clamp pad (2820) degrades and begins to flow,
the clamp pad material can flow outwardly between electrodes (2812)
in clamp arm (2810) since clamp pad (2820) is not completely bound
by clamp arm (2812). This outward flow of degraded clamp pad
material prevents such degraded clamp material from depositing on
tissue-contacting surfaces of clamp arm (2810), or other tissue
contacting surfaces of clamp pad (2820). In this manner a constant
gap is maintained between conductive blade (2840) and conductive
clamp arm (2810) along those portions of clamp arm (2810) having a
conductive pathway from clamp arm (2810), through captured tissue,
and to blade (2840), as shown in FIG. 22B.
FIG. 23 shows an alternate clamp arm (2900) having an electrode
(2910) and clamp pad (2920) configured to provide pad material flow
control similarly as described above. In this example, electrode
(2910) is continuous around the perimeter of clamp arm (2900) and
extends inwardly toward the center line along the length of clamp
arm (2900). The body of clamp arm (2900) defines recesses or
chambers into which the material of clamp pad (2920) may flow as
clamp pad (2920) degrades. Such recesses or chambers may be located
above electrodes (2910) (i.e., further into the page in the view of
FIG. 23), such that as the material of clamp pad (2920) degrades
and is pushed upwardly, the material will not flow out over clamp
arm (2900) and thereby block electrode (2910) from maintaining
electrical continuity with the tissue.
In view of the teachings herein, other ways to configure clamp arms
and clamp pads to provide for flow control of degraded clamp pad
material will be apparent to those of ordinary skill in the
art.
F. End Effector with Conductive Pad and Clamp Arm
FIGS. 24-25 show another exemplary end effector (10) that may be
readily incorporated into instrument (110) in place of end effector
(140). End effector (10) is configured such that a single treatment
region can be defined for both ultrasonic cutting and
electrosurgical sealing. End effector (10) of this example
comprises an ultrasonic blade (14) and a clamp arm assembly (15).
Clamp arm assembly (15) comprises a clamp arm (11), an insulator
(12), and a clamp pad (13). Clamp arm (11) connects with inner tube
(204) via pin (205) and is operable to pivot toward and away from
blade (14) in the manner described above. In this way, instrument
(110) is operable to provide ultrasonic cutting when tissue is
compressed between blade (14) and clamp arm assembly (15), and
blade (14) is activated to oscillate ultrasonically as described
further herein.
End effector (10) also provides electrosurgical sealing by
delivering electrosurgical energy from one electrical pole to
another. In the present example, clamp pad (13) comprises one of
the electrical poles while clamp arm (11) comprises the other of
the electrical poles. In this manner both clamp pad (13) and clamp
arm (11) are conductive and thereby configured to apply electrical
energy, with clamp pad (13) having an opposite polarity to that of
clamp arm (11). In some versions of end effector (10), clamp pad
(13) comprises a custom formulated pad having metallic alloy
particles that are electrically activated. In some other versions,
clamp pad (13) may be formulated with carbon particles, graphene,
and/or other conductive fillers instead of or in addition to
metallic alloy particles. Still in other versions, clamp pad (13)
may comprises a positive temperature coefficient (PTC) material,
which is both conductive and temperature reactive. In view of the
teachings herein, other materials and ways to configure clamp pad
(13) such that clamp pad (13) is electrically conductive will be
apparent to those of ordinary skill in the art. Conductive clamp
pad (13) connects with an electrical source, such as generator
(116), via a cable or other electrical pathway to electrically
activate clamp pad (13).
Clamp arm (11) is also formed of a conductive material as mentioned
above. In the present example, clamp arm (11) is coated with an
insulating material on its outer surface, which faces away from
clamped tissue. The inner surface of clamp arm (11), which faces
the clamped tissue, is not coated with an insulating material such
that the clamped tissue is exposed to the electrically conductive
surface of clamp arm (11) when end effector (10) is providing
electrosurgical sealing. Conductive clamp arm (11) connects with an
electrical source, such as generator (116), via a cable or other
electrical pathway to provide electrical polarity to clamp arm
(11). In the present example, clamp arm (11) is isolated from clamp
pad (13) by way of insulator (12). This isolation using insulator
(12) is configured so that any flow of electrical energy from clamp
pad (13) to clamp arm (11), or vice versa, when clamping tissue,
must be by the electrical energy flowing through the clamped
tissue.
In the present example, blade (14) comprises a coating on at least
a portion of blade (14) such that in the region for ultrasonic
cutting and RF electrosurgical sealing blade (14) is electrically
isolated from electrically activated clamp arm (11) and clamp pad
(13). In some versions, the coating used on blade (14) may
comprises parylene, xylan, or other suitable coatings that
electrically isolate blade (14) from the RF circuit.
During cutting and sealing, clamp arm assembly (15) is actuated to
the closed position such that tissue (T) is compressed between
clamp arm assembly (15) and blade (14) as shown in FIG. 25. To
provide ultrasonic cutting, vibrational energy is applied to blade
(14), which oscillates ultrasonically to sever clamped tissue (T)
at the region where tissue (T) is compressed between blade (14) and
clamp pad (13). To provide RF electrosurgical sealing, with tissue
(T) in the clamped and compressed state, RF electrosurgical energy
is provided from an electrical source, such as generator (116). The
electrical current travels from the positive pole though the tissue
(T) and to the negative pole. In the present example, clamp pad
(13) comprises the positive pole and clamp arm (11) comprises the
negative pole. However, in other versions these poles may be
reversed. Cutting and sealing operations may be performed in any
order or simultaneously. In some instances, only one of the
treatment modalities (ultrasonic cutting being one modality and
electrosurgical sealing being another) may be used with end
effector (10). Where both cutting and sealing modalities are used
for a portion of clamped tissue (T), as best understood from FIG.
25, electrosurgical sealing occurs along both sides of the cut
line, such that both of the cut ends of the tissue (T) are
sealed.
FIG. 26 shows another exemplary end effector (16) that may be
readily incorporated into instrument (110) in place of end effector
(140). End effector (16) is similar to end effector (10) described
above. End effector (16) comprises ultrasonic blade (14) and clamp
arm assembly (19). With end effector (16), instead of electrically
isolating blade (14) by coating blade (14), the electrical energy
for clamp arm (11) and clamp pad (13) is provided by running
insulated wires (17, 18) through the shaft assembly (130) of
instrument (110) in channels (20) positioned within the respective
clamp arm (11) and clamp pad (13). Wires (17) are positioned within
clamp arm (11) in a manner where wires (17) are located on each
side of the clamp arm (11) and spaced away from blade (14) such
that there is a portion of clamp arm (11) between wires (17) and
blade (14). Similarly, wire (18) is positioned within clamp pad
(13) in a manner where wire (18) is spaced away from blade (14)
such that there is a portion of clamp pad (13) between wire (18)
and blade (14). In this manner, blade (14) is electrically isolated
from the RF circuit and the electrosurgical energy is configured to
flow through clamped tissue and wires (17, 18). Cutting and sealing
operations with end effector (16) occur in the same fashion as
explained above with respect to end effector (10).
G. End Effector with Dual Charged Clamp Pads
FIGS. 27 and 28 show another exemplary end effector (40) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (40) comprises a first clamp pad (41),
and a second clamp pad (42). Clamp pad (41) is connectable with
clamp arm (43), and clamp pad (42) is connectable with clamp arm
(44). End effector (40) further comprises blade (45). Each
respective clamp arm (43, 44) and attached clamp pad (41, 42) is
configured to pivot relative to blade (45) between an open position
and a closed position to selectively receive and clamp tissue in
end effector (40). In the present example, this pivotal movement
occurs in the same or substantially the same manner as the pivoting
movement of clamp arm (210) described above. For example, each
respective clamp arm (43, 44) is pivotably coupled with an outer
tube (202) at one pivot point; and with inner tube (204) at another
pivot point. Thus, relative longitudinal movement between tubes
(202, 204) provides pivotal movement of clamp arms (43, 44).
In some versions, instrument (110) may be configured with
additional tubes or adapters that connect with clamp arms (43, 44)
to provide pivotal movement as described herein. Furthermore, clamp
arms (43, 44) and their associated clamp pads (41, 42) are
configured to move either independently or together. In view of the
teachings herein, various ways to configure clamp arms (43, 44)
with instrument (110) to provide this pivotal movement will be
apparent to those of ordinary skill in the art. By way of example
only, clamp arms (43, 44) may be configured and operable to move in
accordance with at least some of the teachings of U.S. Pat. No.
9,237,900, entitled "Surgical Instrument with Split Jaw," issued
Jan. 19, 2016, the disclosure of which is incorporated by reference
herein.
Each clamp pad (41, 42) in the present example is configured with a
different polarity so that an RF electrosurgical circuit or pathway
is created from clamp pad (41), through captured tissue, to the
clamp pad (43), and vice versa. For instance, clamp pad (41) may
have a first polarity while clamp pad (42) may have a second
polarity. As described above, the conductive nature of clamp pads
(41, 42) may be achieved by combining conductive material(s) (46)
with the clamp pad material when manufacturing clamp pads (41, 42).
The conductive clamp pad (41, 42) are then connectable with an
electrical source, such as generator (116), to provide the
respective electrical polarity to clamp pads (41, 42). In view of
the teachings herein, various ways for connecting conductive clamp
pads (41, 42) with generator (116) or another electrical source
will be apparent to those of ordinary skill in the art. Also, any
of the methods and techniques described above for altering or
modifying clamp pad design to shape the electrosurgical circuit or
pathway may be used with clamp pads (41, 42) of end effector (40).
In view of the teachings herein, such alterations or modification
of clamp pads (41, 42) to shape the electrosurgical circuit and
resultant sealing will be apparent to those of ordinary skill in
the art. Furthermore, each clamp arm (43, 44) is electrically
isolated from its respective clamp pad (41, 42) through various
insulating materials as will be understood by those of ordinary
skill in the art in view of the teachings herein.
In the example where clamp arms (43, 44) move independently
relative to blade (45), either or both clamp arms (43, 44) can be
moved to the closed position to compress tissue between the
respective clamp pad (41, 42) and blade (45). Blade (45) can be
activated to oscillate such that compressed tissue will be
ultrasonically severed along the regions where tissue is compressed
between clamp pads (41, 42) and blade (45). Because each clamp pad
(41, 42) in the present example has a different polarity, to
achieve RF electrosurgical sealing, both clamp pads (41, 42) are
moved so that they contact the captured tissue. This is
accomplished by moving each clamp arm (43, 44), containing clamp
pads (41, 42) respectively, to the closed position. With both clamp
arms (43, 44) closed, RF electrosurgical sealing can be provided
via clamp pads (41, 42) either before, during, or after the
ultrasonic cutting process.
H. End Effector with Outriggers with Selective Insulation
FIGS. 29 and 30 show another exemplary end effector (60) that may
be readily incorporated into instrument (110) in place of end
effector (140). End effector (60) comprises clamp arm (61), clamp
pad (62), and blade (63), which are all nonconductive in the
present example. Ultrasonic cutting with end effector (60) occurs
in the manner described above, where tissue is compressed between
blade (63) and clamp pad (62) with blade (63) being activated to
oscillate ultrasonically to thereby sever clamped and compressed
tissue.
To provide RF electrosurgical sealing in a way where blade (63)
remains neutral or nonconductive, and may be coated with xylan or
another suitable coating, end effector (60) further comprises a
first and second outrigger (64, 65) that each extend from shaft
assembly (130). In some other versions, first and second outriggers
(64, 65) may extend from blade (63). In the present example,
outriggers (64, 65) include a coating (66). Coating (66) is applied
selectively to outriggers (64, 65). As shown in the illustrated
version of FIG. 30, the selective coating (66) is applied around
all sides of outriggers (64, 65) except for an exposed surface (67)
of each outrigger (64, 65), which faces or is adjacent to clamp pad
(62).
Coating (66) is configured such that coating (66) prevents blade
(63) from contacting outriggers (64, 65) directly. Coating (66)
also provides insulating properties so as to inhibit the transfer
of electrical energy from outriggers (64, 65) to blade (63) or
clamp arm (61) thereby causing a short circuit to the RF
electrosurgical path as discussed below. In some versions coating
(66) may comprise polytetrafluoroethylene, but other coating
materials may be used as will be apparent to those of ordinary
skill in the art in view of the teachings herein.
In the present example, each of outriggers (64, 65) are conductive.
Furthermore, outriggers (64, 65) have opposite polarities. With
this configuration, when tissue is clamped between clamp arm (61)
and blade (63), a RF electrosurgical circuit or path is defined
that extends from one of outriggers (64, 65) through the clamped
tissue, to the other of outriggers (64, 65). As shown in the
illustrated version, exposed surfaces (67) of outriggers (64, 65),
which are closest to or facing clamp pad (62), are uncoated thereby
allowing electrosurgical energy to flow through the tissue
contacting outriggers (64, 65).
In some versions, selective coating (66) is applied such that the
exposed surfaces (67) of outriggers (64, 65) are uncoated and thus
exposed to clamp pad (62) and clamped tissue along the length of
clamp pad (62). In some other versions, selective coating (66) may
be applied to outriggers (64, 65) in a pattern so as to alter the
pathway of the RF electrosurgical energy flow and thus the
electrical field and the resultant sealing shape or pattern. By way
of example only, and not limitation, several such features and
techniques for altering or manipulating the pathway of the RF
electrosurgical energy are described herein with respect to other
end effector versions. In view of these teachings, such
modifications to the pattern of selective coating (66) on
outriggers (64, 65) to alter the RF electrosurgical pathways and
the resulting sealing patterns will be apparent to those of
ordinary skill in the art. For example, in some versions, instead
of exposed surfaces (67) being uncoated along the length of clamp
pad (62), selective coating (66) may be applied such that exposed
surfaces (67) comprise alternating regions of coating and uncoated
areas.
I. End Effector with Clamp Arm with Overmolded Electrodes
FIG. 31 shows another exemplary end effector (80) that may be
readily incorporated into instrument (110) in place of end effector
(140). End effector (80) comprises clamp arm (81), clamp pad (82),
and blade (83). In the present example, blade (83) is nonconductive
and may be coated with an insulating and/or nonstick material or
coating. Clamp pad (82) is also nonconductive in the present
example. With tissue (T) compressed between clamp pad (82) and
blade (83) when end effector (80) is in a closed position, blade
(83) may be activated and tissue (T) ultrasonically cut or
severed.
In the present example, RF electrosurgical sealing features are
incorporated into clamp arm (81). For instance, clamp arm (81)
comprises an insulator (84) that extends along clamp arm (81) along
each side of clamp pad (82). Insulator (84) is overmolded onto
clamp arm (81), but may be connected with clamp arm (81) other ways
that will be apparent to those of ordinary skill in the art in view
of the teachings herein. First and second electrodes (85, 86) are
each located on and along insulator (84) along each side of clamp
pad (82). In this configuration, clamp arm (81) is electrically
isolated from first and second electrodes (85, 86) by insulator
(84). As will be discussed in greater detail below, each of first
and second electrodes (85, 86) are conductive and first electrode
(85) has an oppositely polarity from second electrode (86). With
this configuration, an RF electrosurgical path is defined extending
through tissue (T) between electrodes (85, 86).
FIGS. 32-34 show other views of clamp arm (81) and the RF
electrosurgical sealing features incorporated therein. As seen in
the illustrated version of FIGS. 92 and 94, in addition to clamp
pad (82) and first and second electrodes (85, 86), clamp arm (81)
includes pull slots (87A, 87B) on each side of clamp arm (81). Pull
slots (87A, 87B) are configured to connect with a tube of shaft
assembly (130) to provide pivoting movement of clamp arm (81) for
opening and closing end effector (80) as described above. In the
present example, pull slot (87A) is formed with and/or connects
with first electrode (85). Similarly, pull slot (87B) is formed
with and/or connects with second electrode (86). In exemplary
versions where pull slots (87A, 87B) are formed with respective
first and second electrodes (85, 86), each of first and second
electrodes (85, 86) comprise a respective longitudinally extending
portion and a respective transversely extending portion. In
particular, the transversely extending portion comprises the pull
slot (87A, 87B) and the longitudinally extending portion extends
along the length of clamp arm (81) on top of insulator (84). It
should further be understood, as shown in FIG. 34, that insulator
(84) also extends transversely, in addition to extending
longitudinally, such that clamp arm (81) is fully isolated from
first and second electrodes (85, 86). With pull slots (87A, 87B)
connecting with first and second electrodes (85, 86) respectively,
and with pull slots (87A, 87B) connectable with a tube of shaft
assembly (130), as will be described further below, one or more
tubes of shaft assembly (130) can be configured to deliver the
electrical energy to first and second electrodes (85, 86).
FIG. 33 shows another view of clamp arm (81), with clamp arm (81)
comprising openings (88) at each side of a top side of clamp arm
(81). Openings (88) are also visible in FIG. 34. Openings (88) are
configured to connect with one or more tubes of shaft assembly
(130). In the present example, openings (88) connect with
corresponding pins or posts located on outer tube of shaft assembly
(130). Pull slots (87A, 87B) connect with corresponding pins or
posts located on inner tube of shaft assembly (130). In this
manner, as described above, clamp arm (81) is pivotable to open and
close by translating inner and outer tubes relative to one another.
In the present example, openings (88) are isolated from first and
second electrodes (85, 86). For example, openings (88) comprise an
overmolded plastic insulating material in the present example. With
this insulating material, outer tube connecting with openings (88)
is also isolated from first and second electrodes (85, 86).
FIGS. 35-36 show a tube assembly (89) with first and second
electrodes (85, 86). Tube assembly (89) comprises outer tube (90),
first half inner tube (91), second half inner tube (92), and
insulator tube (93). Tube assembly (89) may replace outer tube
(202) and inner tube (204) described above, such that shaft
assembly (130) is usable with end effector (80) as further
described herein. In the assembled state for tube assembly (89),
insulator tube (93) sits within outer tube (90). First half inner
tube (91) and second half inner tube (92) each sit within insulator
tube (93). Insulator tube (93) comprises dividers (94) that
separate first and second half inner tubes (91, 92) such that first
and second half inner tubes (91, 92) do not directly contact one
another. Insulator tube (93) further separates outer tube (90) from
first and second half inner tubes (91, 92) such that outer tube
(90) does not directly contact first and/or second half inner tubes
(91, 92).
In the present example, outer tube (90) is nonconductive while
first and second half inner tubes (91, 92) are conductive. First
and second half inner tubes (91, 92) respectively connect with pull
slots (87A, 87B) of first and second electrodes (85, 86) as
described above. First half inner tube (91) is configured to
provide a first electrical polarity to first electrode (85) through
its connection with pull slot (87A). Second half inner tube (92) is
configured to provide a second electrical polarity to second
electrode (86) through its connection with pull slot (87B).
As described above, insulator (84) electrically isolates clamp arm
(81) from first and second electrodes (85, 86). Additionally,
openings (88) are insulated as mentioned. Outer tube (90) includes
elongated member (95) having pins or posts that connect with
openings (88) in clamp arm (81). With this configuration, clamp arm
(81) of end effector (80) connects with both outer tube (90) and
with first and second half inner tubes (91, 92). First and second
half inner tubes (91, 92) are configured to translate in unison. As
described above, with translational movement of first and second
half inner tubes (91, 92) relative to outer tube (90), clamp arm
(81) opens and closes with a pivoting action. In other versions
outer tube may translate relative to first and second half inner
tubes (91, 92) to pivot clamp arm (81).
In the configuration described above, an RF electrosurgical path is
defined as extending through tissue (T) between electrodes (85,
86). When tissue (T) is clamped between clamp arm (81) and blade
(83), tissue (T) can be ultrasonically cut along the region between
clamp pad (82) and blade (83). Furthermore, tissue (T) can be
sealed along each side of the cut line where tissue (T) contacts
first and second electrodes (85, 86).
FIGS. 37 and 38 show another tube assembly (96) that may be used
with end effector (80) instead of tube assembly (89). Tube assembly
(96) is similar to tube assembly (89). However, tube assembly (96)
of this example is configured such that the outer tube provides the
electrical energy to first and second electrodes (85, 86) instead
of the inner tube as in tube assembly (89).
Tube assembly (96) comprises first half outer tube (97), second
half outer tube (98), insulator tube (99), and inner tube (not
shown). Tube assembly (96) may replace outer tube (202) and inner
tube (204) described above, such that shaft assembly (130) is
usable with end effector (80) as further described herein. In the
assembled state for tube assembly (96), insulator tube (99) sits
within first and second half outer tubes (97, 98). Inner tube (not
shown) sits within insulator tube (99). Insulator tube (99)
comprises dividers (170, 171) that separate first and second half
outer tubes (97, 98) such that first and second half outer tubes
(97, 98) do not directly contact one another. Insulator tube (99)
further separates inner tube from first and second half outer tubes
(97, 98) such that inner tube does not directly contact first
and/or second half outer tubes (97, 98). Divider (170) of insulator
tube (99) defines a bore (172) that is configured such that wires
or cables can pass through bore (172) to extend through instrument
(110). Such wires and/or cables can be used to provide electrical
energy to first and second electrodes (85, 86) in some versions
instead of providing electrical energy through inner or outer tube
structures. It should also be understood that wires and/or cables
can be used for electrical grounding.
In the present example, inner tube is nonconductive while first and
second half outer tubes (97, 98) are conductive. First and second
half outer tubes (97, 98) respectively connect with openings (88).
In the present example using tube assembly (96), clamp arm (81) and
first and second electrodes (85, 86) are modified such that
electrical energy may be communicated through openings (88) to
first and second electrodes (85, 86) instead of through pull slots
(87A, 87B) as described above. In view of the teachings herein,
such modifications to clamp arm (81) to transfer electrical energy
to first and second electrodes (85, 86) by way of openings (88)
instead of pull slots (87A, 87B) will be apparent to those of
ordinary skill in the art. In this manner, first half outer tube
(97) is configured to provide a first electrical polarity to first
electrode (85) through its connection, and second half outer tube
(98) is configured to provide a second electrical polarity to
second electrode (86). As shown in FIG. 38, a heat shrink tube
(173) can surround first and second half outer tubes (97, 98) to
isolate other components of shaft assembly (130) and instrument
(110) from conductive first and second outer tube halves (97,
98).
As described above, insulator (84) electrically isolates clamp arm
(81) from first and second electrodes (85, 86). In the present
example using tube assembly (96), insulator (84) and clamp arm (81)
are also modified such that clamp arm (81) remains electrically
isolated from first and second half outer tubes (97, 98). In view
of the teachings herein, such modifications to insulator (84) and
clamp arm (81) to maintain electrical isolation of clamp arm (81)
will be apparent to those of ordinary skill in the art.
Additionally, with tube assembly (96) pull slots (87A, 87B) are
insulated such that inner tube remains electrically isolated from
first and second electrodes (85, 86). With this configuration,
clamp arm (81) of end effector (80) connects with both inner tube
and with first and second half outer tubes (97, 98). First and
second half outer tubes (97, 98) are configured to translate in
unison. As described above, with translational movement of first
and second half outer tubes (97, 98) relative to inner tube, clamp
arm (81) opens and closes with a pivoting action. In some other
versions, inner tube may translate relative to first and second
half outer tubes (97, 98) to pivot clamp arm (81).
In the configuration described above with tube assembly (96), an RF
electrosurgical path is defined as extending through tissue (T)
between electrodes (85, 86). When tissue (T) is clamped between
clamp arm (81) and blade (83), tissue (T) can be ultrasonically cut
along the region between clamp pad (82) and blade (83).
Furthermore, tissue (T) can be sealed along each side of the cut
line where tissue (T) contacts first and second electrodes (85,
86).
FIGS. 39 and 40 show further proximal portions of tube assembly
(89), and in particular connections of first and second half inner
tubes (91, 92) with first and second rings (174, 175) to provide RF
electrical energy to first and second half inner tubes (91, 92),
and ultimately to first and second electrodes (85, 86). In the
present example, first half inner tube (91) connects with first
ring (174), and second half inner tube (92) connects with second
ring (175). Ring (174) further connects with ring contact (176),
which connects with one of the cables that connects with generator
(116) to provide the electrical energy. Ring (175) further connects
with ring contact (177), which connects with the other of the
cables that connects with generator (116) to provide the electrical
energy. In one version, ring contacts (176, 177) comprise contact
springs.
First ring (174) and second ring (175) comprise respective
connection members (178, 179). Connection member (178) contacts
first half inner tube (91) to provide electrical continuity with
first half inner tube (91). Connection member (179) contact second
half inner tube (92) to provide electrical continuity with second
half inner tube (92). In the present example, first ring (174) and
second ring (175) are welded or otherwise fixedly attached to
respective first and second half inner tubes (91, 92). In this
manner, shaft assembly (130) is rotatable 360 degrees and
electrical contact is maintained between first and second rings
(174, 175) and respective first and second half inner tubes (91,
92). In some versions, rings (174, 175) are rotatable relative to
respective first and second ring contacts (176, 177), such that
when shaft assembly rotates, rings (174, 175) rotate also based on
their fixed connection with respective first and second half inner
tubes (91, 92). This rotation of rings (174, 175) is relative to
ring contacts (176, 177). However, ring contacts (176, 177) remain
in electrical contact with respective rings (174, 175), thereby
providing electrical continuity from respective cables to
respective first and second half inner tubes (91, 92), and
ultimately to respective first and second electrodes (85, 86). With
rings (174, 175) rotatable relative to ring contacts (176, 177),
cables within instrument (110) that connect with ring contacts
(176, 177) can remain generally stationary when the shaft assembly
is rotated.
FIG. 41 shows actuation ring (180) with blade (83) passing through
actuation ring (180). In the present example, actuation ring (180)
is configured to connect with first inner half tube (91) and second
inner half tube (92) to translate inner half tubes (91, 92)
relative to outer tube (90) so as to pivot clamp arm (81) to open
and close clamp arm (81). Actuation ring (180) is connectable with
trigger (128) such that clamp arm (81) is pivotable toward
ultrasonic blade (83) in response to pivoting of trigger (128)
toward pistol grip (124); and such that clamp arm (81) is pivotable
away from ultrasonic blade (83) in response to pivoting of trigger
(128) away from pistol grip (124). Various suitable ways in which
actuation ring (180) may be coupled with inner half tubes (91, 92)
and trigger (128) will be apparent to those of ordinary skill in
the art in view of the teachings herein. In some versions,
actuation ring (180) may be connectable with outer tube (90)
instead of with inner half tubes (91, 92) to provide the
translation necessary to pivot clamp arm (81) between open and
closed positions. As shown in FIG. 41, actuation ring (180) may be
configured with a bore (182) that allows wires (181) to pass
through actuation ring (180) in some versions.
J. End Effector with Conductive Pad with Two Poles
FIG. 42 shows another exemplary end effector (150) that may be
readily incorporated into instrument (110) in place of end effector
(140). End effector (150) comprises clamp arm (151), clamp pad
(152), and blade (153). Clamp pad (152) comprises first portion
(154) and second portion (155). An insulator (156) separates first
and second portions (154, 155). Insulator (156) also separates
respective first and second portions (154, 155) of clamp (152) from
clamp arm (151).
Clamp pad (152) is constructed from conductive material (157) such
that first and second portion (154, 155) are each electrically
conductive. Furthermore, each conductive first and second portions
(154, 155) of clamp pad (152) connect either directly or indirectly
with respective cables that lead to generator (116) or another
source of RF electrosurgical power. First and second portions (154,
155) of clamp pad (152) are oppositely polarized. In some versions,
conductive material (157) within clamp pad (152) comprises
conductive fibers that are formed in clamp pad (152). These fibers
may be oriented longitudinally along clamp pad (152) as shown in
FIG. 43. Alternatively, these fibers may be oriented transversely
along clamp pad (152) as shown in FIG. 44. Any other suitable fiber
orientation may be used.
As yet another merely illustrative variation, conductive material
(157) comprises metal that is impregnated within rubber during
clamp pad (152) construction. This metal may also be oriented
longitudinally, transversely, or otherwise along clamp pad (152),
or in any other suitable pattern including a random orientation.
Some exemplary metals that may be used with clamp pad (152) to
impart conductivity to clamp pad (152) include, but are not limited
to, silver, silver-plated aluminum, silver-plated copper,
silver-plated glass, nickel-plated graphite, among others. Another
exemplary conductive material (157) usable with clamp pad (152)
includes black carbon. In view of the teachings herein, other
materials that may be used with clamp pad (152) to make clamp pad
(152) conductive, as well as techniques for incorporating such
materials with clamp pad (152), will be apparent to those of
ordinary skill in the art.
With the orientation of insulator (156) as described above, end
effector (150) first and second portions (154, 155) of conductive
pad (152) provide oppositely polarized electrodes of an RF
electrosurgical pathway or circuit. Furthermore, the electrically
conductive portions of clamp pad (152) are isolated from one
another and from clamp arm (151). With this configuration, a single
treatment region is defined between clamp pad (152) and blade
(153), and both ultrasonic cutting and RF electrosurgical sealing
of tissue sealing can be provided within the single treatment
region.
In some versions, clamp pad (152) is configured as a disposable
clamp pad (152) that wears away gradually as heat is generated by
blade (153). With this configuration, conductive material (157)
within clamp pad (152) may be configured to wear away such that RF
electrosurgical sealing becomes less effective and thereby serves
to indicate the time is right to replace clamp pad (152).
When end effector (150) is used with instrument (110) to cut and
seal tissue (T), as mentioned above a single treatment region is
defined by tissue (T) compressed between blade (153) and clamp pad
(152). With tissue (T) compressed and blade (153) activated,
ultrasonic cutting of tissue (T) occurs along this compressed
region of tissue (T). Additionally, or separately, RF
electrosurgical sealing occurs in this single treatment region.
More specifically, with tissue (T) clamped between blade (153) and
pad (152), an RF electrosurgical pathway or circuit is defined as
extending through tissue between first portion (154) of clamp pad
(152) and second portion (155) of clamp pad (152). In this
exemplary RF electrosurgical circuit, first portion (154) is
provided at a first electrical polarity while second portion (155)
is provided at a second electrical polarity. When using end
effector (150) for ultrasonic cutting and RF electrosurgical
sealing, these modalities may be used in any order, or at the same
time. Furthermore, just one of these modalities may be used in some
applications, such that it is not necessary in all circumstances to
use both modalities with end effector (150).
K. End Effector with Dual Lengthwise Sections
FIG. 45 shows another exemplary end effector (450) configured for
use with a shears device (451). While the present example
illustrates shears device (451), in view of the teachings herein,
the features and techniques pertaining to the ultrasonic cutting
and RF electrosurgical sealing are also applicable to instrument
(110) and one or more of the end effectors described herein that
are readily usable with instrument (110).
In certain procedure, e.g. solid organ procedures, it may be
desirable to crush tissues to divide the parenchymous tissues
without disturbing the vessels and ducts lying within. By way of
example only, this may occur in procedures where a portion of a
patient's liver is removed. After crushing the parenchyma, the
exposed vessels and ducts can then be sealed and cut. In some
instances, larger jaw or clamp arm devices are used with such
procedures. Some such larger jaw or clamp arm devices may include
shears like shears (451) shown in FIG. 45. It should therefore be
understood that the same shears (451) may be used to crush the
parenchyma, sever the exposed vessels and ducts, and seal the
severed vessels and ducts. In view of the teachings herein, other
devices usable in such procedures as described here will be
apparent to those of ordinary skill in the art. Such other devices
include, but are not limited to, instrument (110) and end effectors
readily usable with instrument (110), including end effectors
incorporating modifications based on the teachings described and
shown here with respect to end effector (450).
Referring to FIGS. 45-49, end effector (450) comprises clamp arm
(452), clamp pad (453), blade (454), and blade cover (455). End
effector (450) further comprises two sections that extend
lengthwise along clamp arm (452). The two lengthwise sections
comprise a proximal section (456) and a distal section (457). In
the present example, proximal section (456) is configured for
clamping tissue without or with minimal energy-based cutting.
Instead of being configured for energy-based cutting, proximal
section (456) is configured to provide mechanical crushing of
tissue as described above; and/or to deliver bipolar
electrosurgical energy to seal tissue. Distal section (457) is
configured for cutting tissue by delivering ultrasonic and/or
bipolar electrosurgical energy, where the tissue is cut by way of
ultrasonic energy. While the energy-based cutting section is distal
section (457) in the present example, in some other versions, the
functions of the proximal and distal sections (456, 457) may be
reversed such that the energy-based cutting occurs at proximal
section (456), while the bipolar coagulation and sealing occurs at
the distal section (457).
In the present example, proximal section (456) for sealing and
coagulation includes opposing clamping electrode surfaces that
deliver bipolar electrosurgical energy to clamped tissue. For
instance, the clamp arm side comprises a first electrode (458) and
blade side comprises a second electrode (459). In some versions,
first electrode (458) is configured with clamp arm (452) such that
clamp arm (452) provides a first polarity in the bipolar RF
electrosurgical circuit. In some other versions, first electrode
(458) is configured with clamp pad (453) such that clamp pad (453)
provides a first polarity in the bipolar RF electrosurgical
circuit. In still other versions, first electrode (458) comprises a
conductive plate connectable with clamp arm (452) and/or clamp pad
(453), where the conductive plate is configured to provide a first
polarity in the bipolar RF electrosurgical circuit. In view of the
teachings herein, other various ways to provide first electrode
(458) on clamp arm side of end effector (450) will be apparent to
those of ordinary skill in the art.
In some versions, second electrode (459) is configured with blade
(454) such that blade (454) provides a second polarity of the
bipolar RF electrosurgical circuit. In some other versions, second
electrode (459) is configured with blade cover (455) such that
blade cover (455) provides the second polarity of the bipolar RF
electrosurgical circuit. In still other versions, second electrode
(459) comprises a conductive plate connectable with blade (454) or
blade cover (455), where the conductive plate provides the second
polarity of the bipolar RF electrosurgical circuit. In examples
where second electrode (459) is formed by blade (454), second
electrode (459) can be ultrasonically active even though present in
proximal section (456). In examples where second electrode (459) is
formed by separate components not part of blade (454), second
electrode (459) is not ultrasonically active. Furthermore, even
where second electrode (459) is formed as part of blade (454) and
thus is ultrasonically active, the displacement of blade (454) in
proximal section (456) is about 70% less than the displacement that
occurs at the distal tip of blade (454). In view of the teachings
herein, other various ways to provide second electrode (459) on
blade side of end effector (450) will be apparent to those of
ordinary skill in the art.
In the present example, distal section (457) for ultrasonic cutting
includes clamp pad (453) and blade (454) such that tissue can be
clamped between and severed by ultrasonic cutting when blade (454)
is activated to oscillate ultrasonically. Distal section (457) can
optionally include opposing clamping electrode surfaces that
deliver bipolar energy to clamped tissue so that sealing and
coagulation can be provided in distal section (457) also. For
instance, in an example that includes RF electrosurgical sealing in
distal section (457), the clamp arm side comprises a third
electrode (460) and blade side comprises a fourth electrode (461).
In some versions, third electrode (460) is configured with clamp
arm (452) such that clamp arm (452) provides a first polarity of
the bipolar RF electrosurgical circuit. In some other versions,
third electrode (460) is configured with clamp pad (453) such that
clamp pad (453) provides the first polarity of the bipolar RF
electrosurgical circuit. In still other versions, third electrode
(460) comprises a conductive plate connectable with clamp arm (452)
and/or clamp pad (453), where the conductive plate provides the
first polarity of the bipolar RF electrosurgical circuit. In some
versions, first electrode (458) and third electrode (460) may be
the same structure that spans both proximal and distal sections
(456, 457) of end effector (450). In view of the teachings herein,
other various ways to provide third electrode (460) on clamp arm
side of end effector (450) will be apparent to those of ordinary
skill in the art.
In some versions, fourth electrode (461) is configured with blade
(454) such that blade (454) provides the second polarity of the
bipolar RF electrosurgical circuit. In some other versions, fourth
electrode (461) is configured with blade cover (455) such that
blade cover (455) provides the second polarity of the bipolar RF
electrosurgical circuit. In still other versions, fourth electrode
(461) comprises a conductive plate connectable with blade (454) or
blade cover (455), where the conductive plate provides the second
polarity of the bipolar RF electrosurgical circuit. In some
versions, second electrode (459) and fourth electrode (461) may be
the same structure that spans both proximal and distal sections
(456, 457) of end effector (450). In view of the teachings herein,
other various ways to provide fourth electrode (461) on blade side
of end effector (450) will be apparent to those of ordinary skill
in the art.
FIGS. 46 and 47 show exemplary cross-sections of a version of end
effector (450) where clamp arm (452) provides the first polarity of
the bipolar RF electrosurgical circuit. In distal section (457)
shown in FIG. 46, tissue can be clamped between clamp pad (453) and
blade (454). Blade (454) oscillates ultrasonically to sever the
tissue. Furthermore, in the present example blade (454) provides
the second polarity of the bipolar RF electrosurgical circuit.
Thus, in addition to ultrasonic cutting occurring in distal section
(457), RF electrosurgical sealing and coagulation can occur based
on the RF electrosurgical pathway extending through tissue between
clamp arm (452) and blade (454).
In the illustrated example in FIGS. 46 and 47, blade (454)
comprises a groove (462) that extends along its underside. Groove
(462) aides in minimizing the thermal capacitance of blade (454)
and/or matching the blade's (454) thermal capacitance with that of
clamp arm (452). In the present example, groove (462) extends along
blade (454) through both distal and proximal sections (457, 456).
As seen by comparing blade (454) profile in proximal section (456)
versus distal section (457), groove (462) is more pronounced in
proximal section (456) where RF electrosurgical sealing occurs.
In proximal section (456) shown in FIG. 47, end effector (450)
further includes blade cover (455) that extends along the sides and
underside of blade (454). Blade cover (455) is constructed of a
nonconductive material in the present example, such as a polymer or
ceramic; or coated, dipped, or overmolded stainless steel. As
illustrated, the top surfaces of blade cover (455) are raised or
elevated relative to the top of blade (454) such that clamp arm
(452) engages blade cover (455) when end effector (450) is closed.
In the present example the distance that blade cover (455) is
raised or elevated relative to blade (454) is represented by D1.
Blade cover (455) is also configured such that when clamp arm (452)
engages blade cover (455), blade cover (455) deflects. The
deflection distance in the present example is represented by D2.
The deflection distance is configured to be less than the elevated
distance D1 so that blade cover (455) will prevent electrically
energized clamp arm (452) from contacting electrically energized
blade (454) and thereby short circuiting the desired RF
electrosurgical pathway.
FIGS. 48-49 show other exemplary cross-sections of a version of end
effector (450). With this example, distal section (457) is
configured for ultrasonic cutting without RF electrosurgical
sealing or coagulation. Furthermore, blade (454) lacks groove (462)
along distal section (457). Proximal section (456) in this example
is similar to that described with respect to FIG. 47. However,
clamp pad (453) is omitted along proximal section (456). Again,
blade cover (455) extends above the top of blade (454) to prevent
contact between clamp arm (452) and blade (454) when end effector
(450) is closed.
FIGS. 50 and 51 show exemplary views of a version of end effector
(450) where the poles of the RF electrosurgical circuit are
provided by two conductive plates. FIG. 50 shows distal section
(457) defining one lengthwise section of the clamping area, and in
particular the region where ultrasonic cutting occurs. In the
present example, third electrode (460) sits atop of clamp pad
(453). A molded top holder (463) is positioned above first
electrode (458) and electrically isolates clamp arm (452) from
first electrode (458). On the blade side in distal section (457), a
top surface of blade (454) is exposed and accessible for contacting
clamp pad (453) when end effector (450) is closed. As discussed
above, this configuration provides for ultrasonic cutting of
clamped tissue. At distal section (457), blade cover (455) extends
along the bottom and sides of blade (454), but does not cover the
top surface of blade (454).
Referring to FIG. 51, in proximal section (456) blade cover (455)
surrounds blade (454) on all sides. Second electrode (459) is
positioned on top of blade cover (455) and beneath clamp pad (453).
Furthermore, first electrode (458) extends above and along the
sides of second electrode (459). With this configuration, clamp pad
(453) in proximal section (456) prevents first electrode (458) and
second electrode (459) from directly contacting each other when end
effector (450) is in a closed position and thus preventing a short
circuit. As described above, when tissue is clamped within proximal
section (456), RF electrosurgical sealing and coagulation can be
delivered through RF electrosurgical energy flowing through the
tissue between electrodes (458, 459).
With the configuration of end effector (450) described in the above
examples, a larger jaw or clamp can be used while minimizing the
power needed for ultrasonic cutting since cutting is limited to
only a portion of the entire length of the jaw or clamp. This also
reduces the amount of heat generation associated with larger jaw or
clamp devices. Furthermore, because of the reduced power need,
smaller and/or lightweight transducers can be used.
L. End Effector with Dual Charged Clamp Arms
FIG. 52 shows another exemplary end effector (550) that may be
readily incorporated into instrument (110) in place of end effector
(140). End effector (550) comprises a first clamp arm (551), and a
second clamp arm (552). Clamp arm (551) is connectable with clamp
pad (553), and clamp arm (552) is connectable with clamp pad (554).
End effector (550) further comprises blade (555). Each respective
clamp arm (551, 552) and attached clamp pad (553, 554) is
configured to pivot relative to blade (555) between an open
position and a closed position to selectively receive and clamp
tissue (T) in end effector (550).
In the present example, the pivotal movement of clamp arms (551,
552) occurs in the same or substantially the same manner as the
pivoting movement of clamp arm (210) described above. For example,
each respective clamp arm (551, 552) is pivotably coupled with an
outer tube (202) at one pivot point; and with inner tube (204) at
another pivot point. Thus, relative longitudinal movement between
tubes (202, 204) provides pivotal movement of clamp arms (551,
552). In some versions, instrument (110) may be configured with
additional tubes or adapters that connect with clamp arms (551,
552) to provide pivotal movement as described herein. Furthermore,
clamp arms (551, 552) and their associated clamp pads (553, 554)
are configured to move either independently or together. In view of
the teachings herein, various ways to configure clamp arms (551,
552) with instrument (110) to provide this pivotal movement will be
apparent to those of ordinary skill in the art.
Each clamp arm (551, 552) in the present example is provided with a
different polarity so that an RF electrosurgical circuit or pathway
is created through tissue captured between from clamp arms (551,
552). For instance, clamp arm (551) may have a first electrical
polarity while clamp arm (552) may have a second electrical
polarity. As described above, the conductive nature of clamp arms
(551, 552) may be achieved by combining conductive material(s) (46)
with clamp arms (551, 552). The conductive clamp arms (551, 552)
are then connectable with an electrical source, such as generator
(116), to deliver the electrical energy to clamp arms (551, 552).
In view of the teachings herein, various ways for connecting
conductive clamp arms (551, 552) with generator (116) or another
electrical source will be apparent to those of ordinary skill in
the art. Also, any of the methods and techniques described above
for altering or modifying clamp arm design to shape the
electrosurgical circuit or pathway may be used with clamp arms
(551, 552) of end effector (550). In view of the teachings herein,
such alterations or modification of clamp arms (551, 552) to shape
the electrosurgical circuit and resultant sealing will be apparent
to those of ordinary skill in the art. Furthermore, each clamp pad
(553, 554) is electrically isolated from its respective clamp arm
(551, 552) through various insulating materials as will be
understood by those of ordinary skill in the art in view of the
teachings herein.
In the example where clamp arms (551, 552) move independently
relative to blade (555), either or both clamp arms (551, 552) can
be moved to the closed position to compress tissue between the
respective clamp pad (553, 554) and blade (555). Blade (555) can be
activated to oscillate such that compressed tissue will be
ultrasonically severed along the regions where tissue is compressed
between clamp pads (553, 554) and blade (555). Because each clamp
arm (551, 552) in the present example has a different polarity, to
achieve RF electrosurgical sealing, both clamp arms (551, 552) are
moved to the closed position so that they contact the captured
tissue. With both clamp arms (551, 552) closed, RF electrosurgical
sealing can be provided either before, during, or after the
ultrasonic cutting process.
FIG. 53 shows another exemplary end effector (560) that may be
readily incorporated into instrument (110) in place of end effector
(140). End effector (560) comprises a first clamp arm (561), a
second clamp arm (562), a first clamp pad (563), a second clamp pad
(564), and a blade (565). End effector (560) operates the same or
similar to end effector (550), and thus the discussion above
regarding end effector (550) should be understood to apply also to
end effector (560). A difference between end effector (560) and end
effector (550) pertains to clamp pads (563, 564). With end effector
(560), clamp pads (563, 564) each extend inwardly toward a
centerline longitudinal axis of blade (565). In this configuration,
clamp arms (561, 562) contact clamped tissue at each outer portion
of clamp arms (561, 562). Accordingly, the RF electrosurgical
pathway from one clamp arm (561) to the other clamp arm (562)
extends only from the outer surface of one clamp arm (561) to the
outer surface of the other clamp arm (562). Comparing back to end
effector (550), clamp arms (551, 552) are each in contact with
clamped tissue on both sides of clamp arms (551, 552). Therefore,
with end effector (550) there are four RF electrosurgical pathways
from one clamp arm (551) through clamped tissue (T), and to the
other clamp arm (552).
FIG. 54 shows another exemplary end effector (570) that may be
readily incorporated into instrument (110) in place of end effector
(140). End effector (570) comprises split clamp arm (571) having a
first portion (572) and a second portion (573) that are each
oppositely polarized and isolated from one another by pad (574).
End effector (570) further comprises nonconductive blade (575).
With the split clamp arm configuration, ultrasonic cutting occurs
in the same manner as described above with other single clamp arm
end effectors. RF electrosurgical sealing occurs similarly to such
sealing described above with respect to end effector (560) shown in
FIG. 53, there being a single RF electrosurgical pathway from first
portion (572) to second portion (573).
FIGS. 55-57 show additional clamp pad (584, 594, 596) to clamp arm
(581, 591, 595) configurations. For example, FIGS. 55 and 56 show
configurations where clamp arms (581, 591) each include two
extending portions that may be used to define RF electrosurgical
pathways for sealing. FIG. 57 shows a clamp arm (595) attached with
a clamp pad (596) where clamp pad (596) comprises multiple
capillaries that can be filled with conductive gel to provide RF
electrosurgical energy. In view of the teachings herein, other
modifications to clamp arm and clamp pad to achieve a desired RF
electrosurgical pathway arrangement will be apparent to those of
ordinary skill in the art.
III. Exemplary Combinations
The following examples relate to various non-exhaustive ways in
which the teachings herein may be combined or applied. It should be
understood that the following examples are not intended to restrict
the coverage of any claims that may be presented at any time in
this application or in subsequent filings of this application. No
disclaimer is intended. The following examples are being provided
for nothing more than merely illustrative purposes. It is
contemplated that the various teachings herein may be arranged and
applied in numerous other ways. It is also contemplated that some
variations may omit certain features referred to in the below
examples. Therefore, none of the aspects or features referred to
below should be deemed critical unless otherwise explicitly
indicated as such at a later date by the inventors or by a
successor in interest to the inventors. If any claims are presented
in this application or in subsequent filings related to this
application that include additional features beyond those referred
to below, those additional features shall not be presumed to have
been added for any reason relating to patentability.
Example 1
An apparatus comprising: (a) a body; (b) a shaft assembly extending
distally from the body, wherein the shaft assembly comprises an
acoustic waveguide, wherein the acoustic waveguide is configured to
communicate ultrasonic vibrations; and (c) an end effector, wherein
the end effector comprises: (i) an ultrasonic blade in acoustic
communication with the acoustic waveguide, and (ii) a clamp arm
assembly, wherein the clamp arm assembly is pivotable toward and
away from the ultrasonic blade, wherein the clamp arm assembly
comprises: (A) a first electrode, and (B) a second electrode,
wherein the first and second electrodes are operable to cooperate
to apply bipolar RF energy to tissue.
Example 2
The apparatus of Example 1, wherein the clamp arm assembly defines
a length, wherein the first and second electrodes extend
longitudinally along the length of the clamp arm assembly.
Example 3
The apparatus of any one or more of Examples 1 through 2, wherein
the first electrode is laterally offset from the second
electrode.
Example 4
The apparatus of any one or more of Examples 1 through 3, wherein
the clamp arm assembly further comprises: (A) a clamp arm body, and
(B) a clamp pad, wherein the clamp pad is operable to compress
tissue against the ultrasonic blade.
Example 5
The apparatus of Example 4, wherein the first and second electrodes
are interposed between the clamp pad and the clamp arm body.
Example 6
The apparatus of Example 5, wherein the clamp pad defines a
plurality of openings associated with the first and second
electrodes, wherein the openings are configured to provide tissue
access to the first and second electrodes through the clamp
pad.
Example 7
The apparatus of Example 4, wherein the first electrode defines a
first half of the clamp arm body, wherein the second electrode
defines a second half of the clamp arm body, wherein the clamp pad
is laterally interposed between the first and second electrodes,
wherein the clamp pad includes an electrically insulative
material.
Example 8
The apparatus of Example 4, wherein the clamp arm body defines the
first electrode, wherein the clamp pad defines the second
electrode, wherein the clamp arm assembly further comprises an
electrical insulator interposed between the clamp arm body and the
clamp pad.
Example 9
The apparatus of any one or more of Examples 4 through 8, wherein
the clamp arm body defines a plurality of lateral notches, wherein
the lateral notches are configured to receive an outward flow of
material forming the clamp pad.
Example 10
The apparatus of Example 4, wherein the first electrode comprises a
first wire extending along at least a portion of a length of the
clamp pad, wherein the second electrode comprises a second wire
extending along at least a portion of a length of the clamp pad,
wherein portions of the first and second wires are exposed relative
to the clamp pad to enable contact with tissue being compressed
against the ultrasonic blade by the clamp pad.
Example 11
The apparatus of Example 10, wherein at least a portion of the
first wire and at least a portion of the second wire are fully
contained within the clamp pad.
Example 12
The apparatus of any one or more of Examples 1 through 4, wherein
the first electrode comprises a longitudinally extending body
portion and a plurality of laterally extending portions, wherein
the laterally extending portions of the first electrode are
longitudinally spaced apart from each other, wherein the second
electrode comprises a longitudinally extending body portion and a
plurality of laterally extending portions, wherein the laterally
extending portions of the second electrode are longitudinally
spaced apart from each other.
Example 13
The apparatus of Example 12, wherein the laterally extending
portions of the first electrode are interdigitated with the
laterally extending portions of the second electrode.
Example 14
The apparatus of Example 1, wherein the clamp arm assembly further
comprises: (A) a first arm, wherein the first arm provides the
first electrode, wherein the first arm is pivotable toward and away
from the ultrasonic blade along a first path, and (B) a second arm,
wherein the second arm provides the second electrode, wherein the
second arm is pivotable toward and away from the ultrasonic blade
along a second path.
Example 15
The apparatus of Example 14, wherein the first and second arms are
pivotable independently relative to each other.
Example 16
An apparatus comprising: (a) a body; (b) a shaft assembly extending
distally from the body, wherein the shaft assembly comprises an
acoustic waveguide, wherein the acoustic waveguide is configured to
communicate ultrasonic vibrations; and (